Clinical and Histological Significance of the Testicular Remnant Found on Inguinal Exploration After Diagnostic Laparoscopy in the Absence of a Patent Processus Vaginalis (original) (raw)
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Pediatric Urology Case Reports, 2014
In nonpalpable testis cases, laparoscopically blind-ending vas deferens and testicular vessels prior to entering the internal ring is sufficient to diagnose a "vanishing" testis, which requires no further exploration. Laparoscopic identification of cord structures entering the internal ring is required the exploration of the inguinal canal to find a testis or to rule out a "vanishing" testis". However, the need for further investigation in cases that identified the blindending cord structures on inguinal canal is questioned. Herein, we present a case of the scrotal nubbin along with blind ending cord structures during inguinal exploration.
Role of laparoscopy in patients with previous negative exploration for impalpable testis
Urology, 2003
Objectives. To evaluate the impact of laparoscopy in the treatment of patients with previous negative inguinal exploration for impalpable undescended testes. Methods. A retrospective review was performed of patients who underwent laparoscopy after prior incomplete or "questionable" negative inguinal explorations for nonpalpable undescended testes. Results. Twenty-seven males aged 1 to 22 years old, with 30 impalpable testes, underwent laparoscopy after prior negative open exploration. The operative notes were available for all patients. In 9 patients (33%), blind-ending spermatic vessels, vas deferens, and a closed ring were found. However, in the remaining 18 patients (67%), viable intra-abdominal or inguinal gonads (9 patients) and intra-abdominal remnants (9 patients) were identified. In 1 patient, seminoma of an intra-abdominal testis was present. Conclusions. When a patient is referred with an inconclusive previous open exploration for an impalpable gonad, laparoscopy has an important role in establishing or refuting the diagnosis of an absent testis. Moreover, therapeutic laparoscopy provides definitive options to standard open techniques when a viable testis or remnant is encountered. In this study, laparoscopy proved more accurate than open exploration with operative notes available defining the nature of the exploration.
The value of laparoscopy in the management of non-palpable testis
Journal of Pediatric Urology, 2010
Object: To retrospectively review the value of laparoscopy in the management of impalpable testis. Materials and methods: In 1993e2006, 182 laparoscopies for impalpable testis were performed for a total of 194 testicular units. Five laparoscopic findings were considered: testicular ectopia, intra-abdominal testis, and cord structures that are blind ending, completely absent (agenesis) or entering the internal inguinal ring. Results: In 62 cases an intra-abdominal testis was found; 18 were classified as high and managed by a laparoscopic FowlereStephens procedure. Cord structures entering the inguinal ring were observed in 77 patients and 45 underwent an inguinal exploration: a testis was found in 12 cases and in 33 a remnant was excised. In 35 cases, intra-abdominal blind ending vas and vessels were observed and eight showed testicular agenesis. No major surgical complications were recorded. Follow up ranged from 1 to 3 years. Conclusions: Our study confirms the value of laparoscopy in the management of non-palpable testis, providing a definitive diagnosis by the direct view of spermatic bundle and testis. Ninety-three patients were managed by laparoscopy only, and in 44 it was essential for the subsequent surgical approach. When the internal inguinal ring is patent and/or normal spermatic vessels are present an inguinal exploration is mandatory.
Additional Benefit of Laparoscopy for Nonpalpable Testes: Finding A Contralateral Patent Processus
Urology, 2008
OBJECTIVES To determine the incidence of contralateral patent processus vaginalis discovered at laparoscopy in patients presenting with a unilateral nonpalpable testis. METHODS From August 1997 through February 2006, 159 boys underwent laparoscopic exploration for a unilateral nonpalpable testis. The data were retrospectively reviewed to determine the incidence of contralateral patency, and the results were analyzed with respect to age at repair and side and size of the unilateral nonpalpable testis. RESULTS The median age of the patients was 1.2 years (range 2 months to 16 years). The nonpalpable testis was on the left side in 100 patients (63%) and on the right side in 59 (37%). The testis was absent in 13 patients (8%), atrophic in 78 (49%), and of normal size in 68 (42%). The overall incidence of a contralateral patent processus vaginalis was 19% (30 of 159). A contralateral patent processus vaginalis was seen in 21% of the boys younger than 2 years old, 19% of boys 2 to 5 years old, and 12% of boys older than 5 years. The incidence of a contralateral patent processus vaginalis was no different for patients with right (20%) versus left (18%) nonpalpable testes. Patients with normal-size testes (34%) had a much greater rate of a contralateral patent processus vaginalis than did those with an atrophic/absent testis (8%) (P Ͻ0.001). CONCLUSIONS Our data suggest that the incidence of a contralateral patent processus vaginalis is considerable in patients presenting with a unilateral nonpalpable testis. This is another benefit of laparoscopy in patients with nonpalpable testes.
Journal of Urology, 1999
Purpose: Laparoscopy is a well described modality that provides an accurate visual diagnosis upon which further management of intra-abdominal testes may be based. Laparoscopic Ligation of spermatic vessels as stage 1 of the procedure is a natural extension of laparoscopy. A staged approach provides adequate viability of the intra-abdominal testis. However, it is uncertain whether the more sensitive germ cells survive this procedure in addition to the Sertoli and interstitial cells of the human testis. Survival of germ cells is a prerequisite of later fertility potential.
Journal of Pediatric Endoscopic Surgery
Introduction Diagnostic laparoscopy is the gold standard for evaluating a child with impalpable undescended testis (UDT). During the diagnostic laparoscopy, if the vas and vessels are seen coursing through the inguinal canal, the standard norm is to explore the inguinal canal via an inguinal crease incision. In this study, however, we explored the feasibility of laparoscopic inguinal exploration without any additional inguinal crease incision. Materials and methods The prospective study was done from 1.1.2019 to 30.6. 2019 to assess the feasibility of the laparoscopic inguinal exploration in cases of impalpable undescended testis, where testicular vessels are found to course into the inguinal canal during a diagnostic laparoscopy. The data including the descriptive characteristics, intraoperative findings, and surgical technique were collected and analysed. Results There were 17 cases of impalpable UDT operated in the Department of Pediatric Surgery from January 2019 to June 2019. Mean age of the patients was 8.5 years (1-16 years). Two patients had testicular vas and vessels coursing through the inguinal canal, both of which underwent laparoscopic inguinal exploration. In both of these cases, vas and vessels were found to end in testicular nubbin, at the level of the neck of the scrotum, which were excised laparoscopically, thus avoiding the open inguinal incision. Conclusion Laparoscopic inguinal exploration is a feasible and attractive alternative in cases of impalpable UDT where testicular vas and vessels are found to course through the inguinal ring.
Efficacy of Laparoscopy in the Management of Unilateral Nonpalpable Testis
Iraqi journal of Medical Sciences, 2019
Background Undescended testis is one of the most common malformations seen in the field of pediatric surgery. The most problematic aspect of undescended testis is the diagnosis and treatment of nonpalpable testis. Laparoscopy has been widely used for the diagnosis and treatment of nonpalpable testis. Objective To evaluate the role of laparoscopy in the diagnosis and treatment of unilateral nonpalpable undescended testis. Methods This is a prospective study carried out in the period from December 2012 to December 2017 in the Pediatric Surgery Department of a tertiary hospital in Baghdad. We used laparoscopy in the diagnosis and treatment of 40 patients aged between one and 12 years (median age 4.9 years) with unilateral nonpalpable undescended testis. Boys with a palpable testis at any point were excluded from the study. Surgical procedure was individualized according to the laparoscopic findings either by one stage laparoscopic orchiopexy, two stage Fowler-Stephens procedure or laparoscopic orchiectomy. Results Laparoscopy was able to diagnose the site of the nonpalpable testes in all the patients. Out of 40 nonpalpable undescended testes, 26 testes (65%) were intra-abdominal (12 testes were low intraabdominal, 14 testes were high intra-abdominal). In 9 patients, (22.5 %), the vas deferens and spermatic vessels were found entering the internal inguinal ring. In 3 patients, (7.5 %), the testes were vanishing, and the testes were absent in 2 patients (5%). All patients with low intra-abdominal testes (n=12) were subjected to one stage laparoscopic orchiopexy through the normal inguinal ring. Out of 14 patients with high intra-abdominal testes, 7 patients underwent two staged Fowler-Stephens laparoscopic procedures, while three patients were treated by laparoscopic Prentiss maneuver and the remaining 4 patients underwent immediate laparoscopic orchiectomy due to presence of an atrophied testis. Patients with the vas deferens and spermatic vessels entering the internal inguinal ring (n=9) were treated by orchiopexy via conventional inguinal approach. Conclusion Laparoscopy for unilateral nonpalpable testis has an excellent diagnostic yield combined with high success rate following repair.
ROLE OF LAPAROSCOPY IN NON PALPABLE UNDESCENDED TESTIS
Purpose: To Evaluate Laparoscopic Diagnostic Findings in Nonpalpable Undescended Testes and Analyze the Success Rate & Outcome of Laparoscopic Orchidopexy. Methods: This was a prospective study carried out in the Department of Paediatric Surgery Sri Ramachandra Medical College and Research Institute from June 2006 to December 2008.We used diagnostic and operative laparoscopy in the management of 52 patients with 61 undescended testes. Boys with the palpable testis at any point were excluded from the study. Results: Out of these patients 26(boys), 28 testes (45%) were palpable and 26(boys), 33 testes (54%) were Nonpalpable. Age range from 9 months to 17 years (median age 5.3 years) .Out of 33 Nonpalpable testes 7(21%) were on the right side, 12(36%) on the left and 14(42%) bilateral. Diagnostic Laparoscopy Findings (n= 33) 1. Deep ring was open in 25(75.7%) and closed in 8(24.2%). 2. Vas and Vessels were seen entering the deep ring in 3 patients and thus inguinal exploration carried out 3. Morphology of testes were Hypoplastic 11(33.3%), Atrophic 3(9.09%), Normal 18(54.5%), 4. Blind ending vas and vessels 1(3.03%). Operative Procedures: (n=33) 1. Diagnostic Laparoscopy only :1(blind ending vas and vessels) 2. Inguinal Exploration 3 cases: 2 Orchidopexy, 1 Orchidectomy. 3. Laparoscopic Orchidopexy : 24 4. Laparoscopic Orchidectomy : 5 5. Overall success for Laparoscopic Orchidopexy 24 (92.3%) and Atrophy in 2 (7.6%) testes. 6. Major associated procedure was Laparoscopic division of Persistant Mullerian Structure. 7. Conclusion : 1. Considering all our findings, we believe that laparoscopy conformed its value in the diagnostic and therapeutic approach of Nonpalpable testes, which facilitated the choice of an optimal surgical strategy 2. Diagnostic Laparoscopy in our series provided 100% dependable direction for the definitive management of Nonpalpable testes.
The Journal of Sexual Medicine, 2018
Objectives. To assess the incidence of testicular appendices (Tas), epididymal anomalies (EAs), and processus vaginalis (PV) patency in patients with undescended testis (UT) according to testicular position and to compare them with human fetuses. Methods. We studied 85 patients (108 testes) with cryptorchidism and compared the features with those of 15 fetuses (30 testes) with scrotal testes. We analyzed the relationships among the testis and epididymis, patency of PV, and the presence of TAs. We used the Chi-square test for statistical analysis (< 0.05). Results. In 108 UT, 72 (66.66%) had PV patent, 67 (62.03%) had TAs, and 39 (36.12%) had EAs. Of the 108 UT, 14 were abdominal (12.96%; 14 had PV patency, 9 TAs, and 7 EAs); 81 were inguinal (75%; 52 had PV patency, 45 TAs, and 31 EAs), and 13 were suprascrotal (12.03%; 6 had PV patency, 13 TAs, and 1 EAs). The patency of PV was more frequently associated with EAs (= 0.00364). The EAs had a higher prevalence in UT compared with fetuses (= 0.0005). Conclusions. Undescended testis has a higher risk of anatomical anomalies and the testes situated in abdomen and inguinal canal have a higher risk of presenting patency of PV and EAs.