Archive for the Pediatric Urology

DIAGNOSTIC AND THERAPEUTIC EFFICACY OF LAPAROSCOPY IN THE MANAGEMENT OF THE UNDESCENDED TESTIS

K. MURSI, I. SAAD, A. SALEM, M. EL-GHONIEMY AND A. ABDEL-HAKIM
Urology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.

Purpose: Twenty percent of undescended testes (UDT) are non-palpable. Imaging has shown suboptimal accuracy in locating non-palpable testis (NPT) with laparoscopy proving to be superior. We aim to evaluate the safety and efficacy of laparoscopy in diagnosis and management of NPT.

Materials and Methods: Included patients were >1-year old with NPT. No imaging was done, and laparoscopy was performed all patients. Patients were classified according to diagnostic laparoscopy into 6 types, Type-I: no testes, vas or spermatic vessels, Type-II: a blind- ended vas, Type-III: vas and vessels entering the inguinal canal, Type-IV: testis at internal inguinal ring (IIR), Type-V: testis <1 one inch from IIR, and Type-VI: testis >1 inch from IIR. Stretching maneuver (SM) was added for Type-V. Follow-up included examination and Doppler US 2-months from surgery.

Results: Twenty-five NPT (15 unilateral and 5 bilateral patients) were included. Mean age 1.8 years. Four testes were Type-IV, 14 Type-V, and 7 Type-VI. Three testes were removed due to atrophy. In 8 (32%) testes, Laparoscopic Orchiopexy (LO) was performed (3 Type-IV and 5 Type-V with positive SM). In 14 (56%) testes, Fowler Stephens laparoscopic orchiopexy (FSLO) was done (6 testes Type-V with negative SM and 8 Type-VI). On follow-up, no significant difference in size, site and vascularity was found between FSLO and LO.

Conclusion: Laparoscopy has 100% accuracy in locating NPT. LO and FSLO can be considered treatments of choice for Type-IV and Type-VI NPT, respectively. SM evaluates mobility to contralateral IIR and detects appropriate surgery for Type-V NPT.

Keywords: Laparoscopy; management; undescended; testis.


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