Lapaoscopy, as a diagnostic and therapeutic tool in the management of patients with nonpalpable testes


Background: So far there is much debate as to the next move to be done when nonpalpable testes (NPT) are encountered. Some advocate imaging methods as ultrasonography (US), CT, or MRI. However, none of these has demonstrated to be 100% dependable in predicting the presence or absence of a testis. On the other hand, laparoscopy can be diagnostic and therapeutic as well. Methods: 28 patients with 39 NPT were enrolled. A preoperative US and MRI were performed for all patients followed by laparoscopic exploration. Results: Of the 39 NPT, 23 (59%) were intra-abdominal. Seventeen (44%) of these were viable intra-abdominal and underwent orchidopexy, 6 (15%) were atretic and eventually excised, while 8 (20.5%) were absent or vanishing. In contrast, 8 (20.5%) testes were found to be inguinal, three (7.7%) of them were viable, and 5 (12.8%) were atrophic, and ultimately excised. US localized 17 (43.6%) of these nonpalpable testes, while laparoscopy localized 31 (79.5%) testes, with a P-value of <0.01. In comparison to laparoscopy, MRI localized only 21(53.8%) of these testes with a P-value of < 0.05. Overall, the sensitivity, specificity, and accuracy of US and MRI were (54.8%, 12.5%, and 46.1%), and (67.7%, 50%, and 64.1%) respectively. Seven viable intra-abdominal testes (18%) were fixed with one-stage orchidopexy, and 10 (25.6%) testes were fixed with two-stage orchidopexy. Three viable inguinal testes (7.7%) underwent inguinal orchidopexy. Totally 11 (28.2%) testes were excised (6 intra-abdominal and 5 inguinal), while eight testes (20.5%) were vanishing. Additionally 4 hernias (10.3%) were simultaneously repaired inguinally. Conclusion: Neither US nor MRI correctly localize a true NPT. In contrast, laparoscopy is safe, precise, and aids in subsequent surgical planning