[The non-palpable testis: modern diagnostic and therapeutic approaches]

Management of the nonpalpable testis is controversial and can be difficult as shown by the multiple modalities for evaluation and proposed treatment. In our opinion, laparoscopy is the ideal first step in the management of patients with a nonpalpable testis, having a great reliability in locating or confirming absence of an occult testis. Accurate preoperative assessment and localization will assist in selecting the appropriate surgical approach either laparoscopic, laparoscopic-assisted, or open procedure. Laparoscopy was performed on 74 patients with 86 nonpalpable testis. The technique has been demonstrated to be extremely safe and lead to diagnosis in 100% of cases. Surgical management of nonpalpable testis was directly performed by laparoscopy identifying intra-abdominal vanishing testis and locating an intra-abdominal or inguinal testis. The two-stage Fowler-Stephens orchiopexy was performed in 41 patients. The first stage consisted of laparoscopic clip ligation of the spermatic vessels. Of these, 32 underwent the second stage by vas-based orchiopexy; all testes, but-one, showed a normal size and consistency. To conclude, we advocate the use of laparoscopy in all boys with nonpalpable testis.