Laparoscopic management of nonpalpable testis: 5 years’ experience at Dhaka Shishu (Children) Hospital

Abstract

Cryptorchidism or undescended testis is one of the most common genitourinary disorders in young boys, where the testis can’t be reached at the bottom of the scrotum.1 3-5% of full termand1845%ofpre-termnewborn boys are born with either unilateral or bilateral undecided testes. The prevalence drops to1-2% by three months of age and 0.8% will still have cryptorchidism attend of 1 years.2-4 Smolko et al.,5 reported that 20% of undescended testes are clinicallynonpalpable.5 The non palpable testis can be non-present, atrophic, or have a failure to descend and be found in ahighscrotal, inguinal, orintra-abdominal location. Most of the literatures report that approximately 20–40%ofnon-palpabletestesareintraabdominalinlocation.6 Localization of the Nonpalpable testis is a significant problem in pediatric age group. The diagnostic methods are Ultra sonography, CT scan, MRI and laparoscopy have been used to locate non palpable testis.7 In a case with Nonpalpable testis, the classical approach was in guinal exploration, if testis found then orchiopexy. If testis cannot be found, then the procedure is preceded with open abdominal exploration.8 But, unplanned groin exploration may be detrimental to the outcome of surgery and sometime fruitless.9 Use of laparoscopy was firstly recommended by Cortesietal in1976 to locate non palpableundescended testes and laparoscopic orchidopexy was firstly performed by Jordan et al., in 1992.8 Nowadays, laparoscopic procedure is a gold standard in the management of patients with a Nonpalpable testis for localization and to plan subsequent surgical management in many centers.10 Wide screen behereour institutional experience with laparoscopic management of Nonpalpable testes in children over the last 5years.