Laparoscopy for impalpable testes: significance of the patent processus vaginalis

Laparoscopy often is performed in the evaluation of boys with an impalpable testis. Previously it has been reported that if laparoscopy disclosed a patent processus vaginalis the testis was likely to be present, whereas if the processus vaginalis was closed then the testis usually was absent. This study was performed to examine this association further. In 111 boys with 124 impalpable testes 45 testes (36%) were viable and suitable for orchiopexy, including 7 that were in the inguinal canal and 38 intra-abdominal testes. Another 79 testes (64%) were absent or vanishing, including 72 in which the cord structures had descended through the internal ring, 5 in which the vas and vessels ended blindly in the abdominal cavity, and 2 in which the testis, vas and vessels could not be identified. When a patent processus vaginalis was present 43 of 47 testes (91%) were viable, whereas if it was closed 75 of 77 (97%) had vanished or were absent. An algorithm for surgical management of the impalpable testis based on laparoscopy findings is proposed.