Surgical exploration for impalpable testis: Which should be first, inguinal exploration or laparoscopic abdominal exploration?
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Published on: February 10, 2023
Akihiro Igarashi1, Kenta Kikuchi1, Kenjiro Ogushi1
1Department of Pediatric Surgery, Dokkyo Medical University Koshigaya Hospital, 2-1-50, Minami-Koshigaya, Koshigaya, Saitama, 343-8555, Japan.
Insights
For impalpable testes in children, initial inguinal exploration is recommended. Laparoscopic exploration is advised if an abdominal testis is not found, optimizing surgical outcomes for undescended testes.
Area of Science:
- Pediatric Surgery
- Urology
- Developmental Biology
Background:
- Undescended testes (cryptorchidism) affect 1-3% of male infants.
- Impalpable testes present a diagnostic and surgical challenge.
- Optimal management strategies are crucial for preventing complications like infertility and malignancy.
Purpose of the Study:
- To evaluate the optimal surgical approach for impalpable testes in children.
- To review treatment outcomes from personal experience and existing literature.
Main Methods:
- Retrospective review of 72 impalpable testes in 68 pediatric patients (ages 6-140 months).
- Initial inguinal exploration followed by laparoscopic exploration if testes were not identified.
- Literature search of surgical exploration for impalpable testes over the past 20 years.
Main Results:
- Inguinal exploration identified testes in 39% (28/72), primarily intracanalicular or low abdominal.
- Laparoscopic exploration was required in 61% (44/72) of cases.
- Vanishing testes were diagnosed in 55.6% (40/72); high abdominal testes in 5.6% (4/72).
Conclusions:
- Recommend initial inguinal exploration for impalpable testes due to low incidence of high abdominal testes.
- Transinguinal laparoscopic exploration is indicated when testes are not found during inguinal exploration.
- This approach balances diagnostic yield and surgical invasiveness.
Purpose:
To discuss an optimal surgical approach for impalpable testis in children, our own treatment results and those reported in the literature were reviewed.
Materials And Methods:
Seventy-two impalpable testes were diagnosed in 68 patients: unilateral in 64 patients and bilateral in 4 patients. All patients underwent surgical exploration at the ages of 6 to 140months (median, 15months). The inguinal canal was initially explored, and abdominal exploration was performed with laparoscopy when an extra-abdominal testis was not identified. In addition, articles regarding surgical exploration for impalpable testis, published over the last 20years, were retrieved and the results were examined.
Results:
Testes were detected by inguinal exploration in 28 of 72 (39%) impalpable testes: intracanalicular in 22 testes and at the internal inguinal ring (peeping or low abdominal testis) in 6 testes. All these testes were treated by conventional inguinal orchidopexy. Laparoscopic exploration was performed in 44 (61%) impalpable testes, and 4 (5.6%) high abdominal testes were detected and treated by two-stage Fowler-Stephens orchidopexy. Vanishing or absent testis was the final diagnosis in the remaining 40 testes (55.6%). The literature review showed that the ratios of intra- and extra-abdominal testes were lower in the articles that reported the results of inguinal or scrotal exploration than in those of laparoscopic exploration, although the difference was not significant.
Conclusions:
Considering the relatively low incidence of high abdominal testis, we recommend to start with inguinal exploration for impalpable testis. When an extra-abdominal testis is not detected, transinguinal laparoscopic exploration should be indicated.
Level Of Evidence:
Treatment study, Level IV.
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