In Which Patients and Why Is Laparoscopy Helpful for the Impalpable Testis?

Area of Science:

• Pediatric Surgery
• Urology
• Minimally Invasive Surgery

Background:

• Laparoscopy is increasingly used for nonpalpable testes (NPT) but its indications remain debated.
• A retrospective review was conducted to evaluate the diagnostic and surgical utility of laparoscopy in NPT management.
• Selective application of laparoscopy is crucial for individual patient treatment plans.

Purpose of the Study:

• To assess the diagnostic accuracy of laparoscopy in identifying the location and condition of nonpalpable testes.
• To evaluate the effectiveness of laparoscopic surgical strategies for intra-abdominal testes (IAT) and other findings.
• To determine the benefits of laparoscopy in guiding treatment decisions for NPT.

Main Methods:

• Retrospective review of 135 patients with NPT managed between 2015 and 2019.
• 95 patients underwent diagnostic laparoscopy; findings included intra-abdominal testes (IAT), blind-ending cords, absent cords, or cords entering the abdominal ring.
• Surgical interventions included primary orchidopexy, Fowler-Stephens (FS) laparoscopic procedures, and open exploration.

Main Results:

• Laparoscopy identified IAT in 48 cases, leading to primary orchidopexy (42 patients) or FS laparoscopic procedure (6 patients).
• Post-operative outcomes included testicular atrophy in 1 patient (primary orchidopexy) and 1 patient (FS procedure).
• Exploration of cords entering the inguinal ring revealed hypotrophic testes in 3 cases, treated with open orchidopexy; others showed viable or degenerated testicular tissue.

Conclusions:

• Careful clinical examination is essential for selecting patients for laparoscopy.
• Diagnostic laparoscopy provides crucial anatomical information for treatment planning in NPT cases.
• Laparoscopy offers significant benefits in managing intra-abdominal testes, with various surgical strategies yielding good results.