[Use of pediatric laparoscopy for nonpalpable testis]

Children with nonpalpable testes create a clinical dilemma because it is difficult to determine the location or absence of the testis by clinical examination. Twenty-two children with unilateral nonpalpable tests underwent successful laparoscopic management under general anesthesia. In 11 (50%) of the patients, the vas deferens and the spermatic vessels exited the internal inguinal ring via the normal anatomy. Either hypoplastic testes or inguinal vanishing testes were found during inguinal exploration in 8 children with normal anatomy but smaller spermatic vessels exiting the internal inguinal ring. Four patients (18%) with blind end of vas and vessels terminating proximal to the internal inguinal ring were considered to be cases of intra-abdominal vanishing testis and no further surgery was necessary. Laparoscopy revealed 7 intra-abdominal testes (32%) which were managed by laparoscopic orchiectomy, simple orchiopexy, trans-abdominal orchiopexy or laparoscopic staged orchiopexy depending on the patient's age and the gonadal intra-abdominal location.