Although the management of boys with palpable testes has been standardized, there are no formal guidelines for the management of boys with nonpalpable testes . Laparoscopy is currently the most reliable diagnostic modality in the management of impalpable testes. It clearly shows the anatomy and provides visual information selleck chem inhibitor upon which a definitive decision can be based . Three main laparoscopic findings are possible: intraabdominal testis, observed in 40% of patients; intra-abdominal blind-ending cord structures, observed in 15%; cord structures entering the internal inguinal ring, observed in 45% . Although the right side is more frequently in undescended testes (45%) in comparison to left side (35%), we have found in our study that 57% of the patients with unilateral nonpalpable testes were in the left side while 43% in the right side.
If no testis can be visualized or the vas or vessels end blindly before the ring, a thorough laparoscopic examination should be performed, especially since gubernacular blood vessels can be mistaken for blind-ending spermatic vessels . If the blind-ending vessels are not accompanied by an associated vas deferens, an ectopic testis should be suspected . Despite 15 years of international research on the topic, there are no guidelines on the management of boys with nonpalpable testes . If an intra-abdominal testis is normotrophic, the optimal method of performing an orchidopexy must be chosen [14�C16]. For example, if the testis is located at the internal ring without looping of the vas, laparoscopic orchiopexy without division of the spermatic vessels may be performed, but the testis may not reach the bottom of the scrotum .
Routine open inguinal orchiopexies has yielded good results, as shown by testicular size and position, in patients with type 1 testes, in which the vas and vessels enter the internal ring. In patients with type 2, however, where the testes are low or at the internal ring but the vas does not loop distally, we routinely test the length of the spermatic cord to determine the potential for successful setting of the testes in their hemiscrotal home. This test consists of pulling the testis towards the contralateral internal ring; if it reaches there comfortably, there is a high possibility of easy fixation. Over the 100 testes included in this study, 7 were in this category.
In type 3 where the testes have difficulty in reaching the contralateral internal ring, laparoscopically staged Fowler-Stephen orchiopexy is the procedure of choice. We observed a success rate of 42.9%, comparable to previous findings. We found that the total success Cilengitide of orchiopexy was 63.3% in line with previously reported rates (Table 2). Table 2 Total success rate of orchiopexy in our study and in previous studies. In conclusion, laparoscopy is an extremely useful and safe modality for both the diagnosis and management of impalpable testes.