The study aimed to evaluate the diagnostic yield of exploratory laparoscopy (EL) and the feasibility of
therapeutic laparoscopy and its outcome for management of impalpable testis (IT). The study included 23
patients; 7 patients had bilateral and 16 patients had unilateral IT and 5 of them had previous negative
groin exploration. After full clinical examination and ultrasonographic examination, all patients had (EL)
followed by one-stage or two-stage Fowler-Stephens (FS) procedure for orchidopexy according to
exploratory findings. (EL) was conducted successfully in all patients with a mean duration of 23.22.S
minutes and a mean total operative time of 90.6.11.8 minutes. (EL) defined 3 vanished testes (10%), 2
small testicular remnant and one grossly dysmorphic intra-abdominal testicle. Two-stage procedure was
applied for 9 testicles, but one testicle was non-viable on the second- stage laparoscopy and orchidectomy
was performed with a failure rate of 11.1%. Successful orchidopexy was achieved in 23 testicles and
orchidectomy was conducted for 4 testicles (13.3%). Throughout follow-up period only 3 testicles (13%)
were high up in the neck of the scrotum but no testicle retracted to be intracanalicular. Nineteen testicles
showed progressive increase in size approaching the size of normal age-cross matched boys, 3 testicles
were stationary while one testicle decreased in size compared to its immediate postoperative size.
Conclusion, laparoscopic management of (IT) could be considered as a safe and effective surgical option
irrespective of its location and could spare subsequent inguinal exploration in 16.7% with a final success
rate of 87%. Two-stage (FS) procedure provided good results for (IT) with short vessels and appropriate
vas length with a second stage failure rate of 11.1%.
Keywords: impalpable testis, Laparoscopy, Fowler-Stephens procedure |
