Role of laparoscopy in the management of impalpable testis in children: Approach in our country

Abstract

Introduction: Treatment of the cryptorchid testicle is essential due to the increased risk of infertility and malignancy as well as the risk of testicular trauma and psychological stigma on patients and their parents. Approximately 20% of cryptorchid testicles are impalpable. In these cases, the laparoscopy is the method of choice for both diagnostic and theraputic requirements.

Materials and Methods: Between 1, April 2009 to 31, October 2010, 37 testicles of 30 patients were submitted to diagnostic laparoscopy for impalpable testes. This was a prospective study to evaluate the diagnostic accuracy and therapeutic outcomes of use of laparoscopy in impalpable testes. Age, operative techniques, complications, the cosmetic aspect and outcomes were also recorded.

Results: Mean age was 6.64 ± 3.96 years and 23% cases were bilateral. Twenty one cases had primary orchiopexy, 9 had 1 st stage Fowler-Stephens (FS) procedure, 3 had 2nd stage FS, 13 cases needed inguinal exploration and there was I vanishing testicles. Average operating time was 40 minutes for diagnostic laparoscopy, 90 minutes for unilateral and 120 minutes for the bilateral cases. Two of the patients had late postoperative complications e.g. one uretereral obstruction and one recurrence.

Conclusions: In pediatric age group, the laparoscopic approach is safe and feasible. The purpose of study is to observe whether the laparoscopic procedure presents excellent results in terms of diagnosis and therapy of the impalpable testis.

Journal of Paediatric Surgeons of Bangladesh (2017) Vol. 8 (1): 15-19