[MRT in nonpalpable testes]

Is laparoscospic orchidectomy the treatment of choice in adults with impalpable testis in rural hospitals in the developing world?

This study was undertaken in order to evaluate the feasibility and safety of performing laparoscopic orchidectomy (LO) in men for unilateral impalpable testis in non-teaching rural hospitals in a developing country. We also investigated the possibility of reducing the cost and length of stay in hospital for patients undergoing LO. This is a prospective analysis of patients with impalpable testis undergoing LO in three non-teaching rural hospitals in the Kashmir Valley from January 2001 to March 2007. The cohort represented men requiring LO aged 15 to 62 (mean 36.2) years. The main outcome parameters assessed included mortality, conversion to an open procedure, complications, reduction in the costs and the length of the hospital stay. Forty-eight men with unilateral undescended testis on physical examination were studied. During laparoscopy the testis was identified near the deep ring in 30 patients, intra-abdominally in 16, and two had blind-ending vas and spermatic vessels near the deep ring. In 46 patients orchidectomy was performed. There were no deaths and none of the patients required conversion to an open procedure. Using reusable instruments, 00 degrees polyglactin sutures and self-made extraction bags, about US$ 300/patient was saved. There was no case of malignancy of the testis on histopathology examination. LO is one of the most satisfactory methods for the management of men with impalpable testis, having both a diagnostic and a therapeutic role especially for patients in the underdeveloped countries. These simple methods can reduce the cost and the length of the hospital stay.

Laparoscopic Management of the Adult Nonpalpable Testicle

OBJECTIVES

This report describes own experiences with laparoscopic management of adult men with cryptorchidism.

PATIENTS AND METHODS

8 men with nonpalpable testes were referred to our department. Laparoscopy was used to assess the presence and location of the gonad and perform an orchiectomy or orchidopexy, respectively.

RESULTS

A uni-/bilateral atrophic testicle was palpable in 2 patients under general anesthesia and removed after inguinal exploration. In 4 individuals the testicular vessels and vas deferens were found laparoscopically entering the internal inguinal ring. Two vanishing testicles and 2 atrophic gonads were removed during subsequent inguinal exploration. In 1 patient with a solitary testis, a morphologically intact abdominal testicle was presented. In this patient, endocrine function was lost completely after stage 1 of a Fowler-Stephens orchidopexy. In 1 patient an atrophic abdominal testicle was removed laparoscopically.

CONCLUSIONS

These results demonstrate the suitability of laparoscopy for the treatment of cryptorchidism in the adult population. In most cases, atrophic inguinal gonads or vanishing testicles are found and should be removed. Our results suggest that in cases of intact abdominal testicles, Fowler-Stephens orchidopexy with transection of the spermatic vessels should be avoided to preserve endocrine function of the gonad.

Accuracy of ultrasonography and magnetic resonance imaging in the diagnosis of non-palpable testis

BACKGROUND

Studies were needed to evaluate the accuracy of ultrasonography (US) and magnetic resonance imaging (MRI) for diagnosing non-palpable testis, and to study the clinical usefulness of US and MRI before surgical exploration.

METHODS

Fifty-six patients with non-palpable testis aged 1--12 years were examined between 1993 and 2002. Forty-six patients (55 non-palpable testes) underwent US. Forty patients (47 non-palpable testes) were examined using MRI. Both US and MRI were used in 29 patients (34 non-palpable testes). We used Fisher's exact probability test to compare the results of these graphic examinations with the surgical or laparoscopic findings for the non-palpable testis.

RESULTS

Ultrasonography had a sensitivity of 76%, a specificity of 100%, and an accuracy of 84% in the diagnosis of non-palpable testis, whereas MRI had a sensitivity of 86%, a specificity of 79%, and an accuracy of 85%.

CONCLUSIONS

There were no statistically significant differences in the accuracy rates of US and MRI for diagnosing non-palpable testis. Laparoscopy or inguinal exploration should be performed even if these graphic examinations demonstrate the absence of a testis, because some patients with a non-palpable testis were found to be false negatives. We recommend US as the first step after clinical examination, and MRI could be performed when the US findings are negative preoperatively for a non-palpable testis.

The role of laparoscopy in the management of impalpable testes

Both diagnostic and operative laparoscopy were used in the management of 68 impalpable testes. Twenty-three were either vanishing or atrophied, and were associated with a precarious blood supply. Two were found in the groin, 12 in the inguinal canal, and 32 at variable distances from the internal ring; of these, 2 were in a patient with persistent müllerian duct syndrome. Two atrophied abdominal testes were removed laparoscopically, 3 patients underwent a two-stage Fowler-Stephens procedure, and 28 underwent one-stage, laparoscopically assisted orchidopexy. An algorithm for surgical management of the impalpable testis based on laparoscopic findings is proposed.