Is laparoscopic re-evaluation justified in cryptorchidism with previous negative open exploration?

Area of Science:

• Pediatric Surgery
• Urology
• Minimally Invasive Surgery

Background:

• Nonpalpable testes represent 20% of cryptorchidism cases.
• Open exploration has historically been used for impalpable testes, with laparoscopy now being the standard.
• Concerns exist regarding missed diagnoses in prior open explorations, particularly for abdominal gonads prone to cancerous degeneration.

Purpose of the Study:

• To evaluate the efficacy of laparoscopic re-exploration in patients with a history of inconclusive open exploration for nonpalpable testes.
• To determine the incidence of missed gonads in patients with prior negative open explorations.

Main Methods:

• A consecutive series of boys with nonpalpable testes and a history of inconclusive open exploration were offered laparoscopic re-exploration.
• Diagnostic laparoscopy was performed, with same-stage orchiopexy or Fowler procedure as indicated.
• The presence, number, and location of detected gonads were meticulously recorded.

Main Results:

• 141 male patients (171 nonpalpable gonads) underwent laparoscopic exploration without adverse events.
• Sixteen patients (19 gonads) with prior negative open exploration were re-evaluated.
• Seven previously undetected gonads were found: 5 in the iliac region and 2 retrovesically.

Conclusions:

• Laparoscopic re-exploration is valuable for identifying nonpalpable testes missed during prior open surgery.
• This approach is particularly recommended for children with hormonal evidence of functioning gonadal tissue after bilateral inguinal exploration.
• Laparoscopic re-evaluation is advised for most patients with nonpalpable testes and a history of negative open exploration.