Laparoscopic management of impalpable testes in pediatric age group

Abstract EN

Aim of the study : The purposes of our study are to evaluate the role of laparoscopy in localizing impalpable testes and the management strategy for both unilateral and bilateral impalpable testes.

Patients and methods : Throughout the period between January 2005 to December 2008, 36 patients with impalpable testes were admitted to pediatric surgery centre at Al-Khanssa Teaching Hospital in Mosul, Laparoscopy done for them to assess and manage 42 impalpable testes.

In all patients 10 mm canula port was inserted in surpaumbilical position using an open technique, a single 5 mm port was occasionally required in contralateral iliac fosse to manipulate bowel and testes.

A further port was used for laparoscopic clipping and division of the testicular vessels.

These performed as the first part of the one or two stages Fowler- Stephen orchiopexy (high division of testicular vessels), and all patients has been followed for period of about two years.

Results : Twenty seven testes found to be positive, ten of them near the internal inguinal ring and nine in the iliac fossae, while two testes where found intra canalicular.

Fifteen testes were absent with closed ring, 12 of them showed vas and vessels enter the internal ring (vanished testes), while three with no vas and vessels entering the ring (agenesis).

Assisted laparoscopic orchiopexy using sub dartous pouch was successfully done in 16 testes.

Single stage Fowler-Stephen technique was adopted in four testes.

Two stages for another two testes, in one patient, fixation done near upper scrotum which was then re fixed by second operation few months later.

Conclusion : Laparoscopy is a safe and reliable technique in diagnosing the presence or absence of impalpable testes, provides a valuable information about the associated anomalies and condition of the internal ring, it can direct the surgeon to chose the proper technique for orchiopexy, with no mortality and very low morbidity.