Current findings in diagnostic laparoscopic evaluation of the nonpalpable testis

Lars J. Cisek, Craig A. Peters, Anthony Atala, Stuart B. Bauer, David A. Diamond, Alan B. Retik

Research output: Contribution to journalArticle

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Abstract

Purpose: We delineate the current findings and contribution of diagnostic laparoscopic evaluation in the management of nonpalpable testis. Materials and Methods: We reviewed all cases in which laparoscopy was considered the management associated with a nonpalpable testis in a 4-year period. Since our previous series, we have performed a careful examination for the testis after induction of anesthesia but before committing to laparoscopy. We recorded testis position and quality, character of the vas deferens and spermatic vessels, type of management and contribution of laparoscopy. We also reviewed contemporary published series and collated the findings of studies performed elsewhere. Results: We identified 263 nonpalpable testes in 225 patients between September 1992 and 1996. In 40 patients 46 testes (18%) were found during physical examination under anesthesia. Of the remaining cases considered appropriate for laparoscopy 215 with complete records were further analyzed. Only 12.6% could be considered missed on examination due to a viable testis distal to the inguinal ring. Of the testes 45.7% would have been found during inguinal exploration alone. In 9.8% of the patients there were intra-abdominal vanishing testes, while 4.2% had indeterminate cord structures on inguinal exploration that would have prompted abdominal extension without a laparoscopic demonstration that the vas and vessels entered the canal. A conventional inguinal incision would have provided optimal exposure for operative management in 34% of the testes. For testes distal to the internal ring when the vas and vessels were distinctly atretic we never identified a viable testis, while a normal appearing vas and vessel were associated with a 45% chance of a salvageable testis. Laparoscopy was informative regarding testis position in all cases in which it was performed. Conclusions: In 13.2% of the cases laparoscopic findings precluded unnecessary abdominal exploration. The typical surgical incision for inguinal exploration would have left the surgeon compromised in 66% of the cases compared to the approach optimized as a result of laparoscopic testicular localization. Of the patients 34% arguably did not benefit from laparoscopy versus inguinal exploration. A simple examination under anesthesia significantly decreases the number of uninformative laparoscopic evaluations, and it is well worth the cost of a few minutes of operative time.

Original languageEnglish
Pages (from-to)1145-1150
Number of pages6
JournalJournal of Urology
Volume160
Issue number3 II
DOIs
StatePublished - Jan 1 1998
Externally publishedYes

Fingerprint

Testis
Groin
Laparoscopy
Anesthesia
Inguinal Canal
Vas Deferens
Operative Time
Physical Examination
Spermatozoa
Costs and Cost Analysis

Keywords

  • Abnormalities
  • Cryptorchidism
  • Laparoscopy
  • Testis

ASJC Scopus subject areas

  • Urology

Cite this

Cisek, L. J., Peters, C. A., Atala, A., Bauer, S. B., Diamond, D. A., & Retik, A. B. (1998). Current findings in diagnostic laparoscopic evaluation of the nonpalpable testis. Journal of Urology, 160(3 II), 1145-1150. https://doi.org/10.1016/S0022-5347(01)62721-6

Current findings in diagnostic laparoscopic evaluation of the nonpalpable testis. / Cisek, Lars J.; Peters, Craig A.; Atala, Anthony; Bauer, Stuart B.; Diamond, David A.; Retik, Alan B.

In: Journal of Urology, Vol. 160, No. 3 II, 01.01.1998, p. 1145-1150.

Research output: Contribution to journalArticle

Cisek, LJ, Peters, CA, Atala, A, Bauer, SB, Diamond, DA & Retik, AB 1998, 'Current findings in diagnostic laparoscopic evaluation of the nonpalpable testis', Journal of Urology, vol. 160, no. 3 II, pp. 1145-1150. https://doi.org/10.1016/S0022-5347(01)62721-6
Cisek LJ, Peters CA, Atala A, Bauer SB, Diamond DA, Retik AB. Current findings in diagnostic laparoscopic evaluation of the nonpalpable testis. Journal of Urology. 1998 Jan 1;160(3 II):1145-1150. https://doi.org/10.1016/S0022-5347(01)62721-6
Cisek, Lars J. ; Peters, Craig A. ; Atala, Anthony ; Bauer, Stuart B. ; Diamond, David A. ; Retik, Alan B. / Current findings in diagnostic laparoscopic evaluation of the nonpalpable testis. In: Journal of Urology. 1998 ; Vol. 160, No. 3 II. pp. 1145-1150.
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abstract = "Purpose: We delineate the current findings and contribution of diagnostic laparoscopic evaluation in the management of nonpalpable testis. Materials and Methods: We reviewed all cases in which laparoscopy was considered the management associated with a nonpalpable testis in a 4-year period. Since our previous series, we have performed a careful examination for the testis after induction of anesthesia but before committing to laparoscopy. We recorded testis position and quality, character of the vas deferens and spermatic vessels, type of management and contribution of laparoscopy. We also reviewed contemporary published series and collated the findings of studies performed elsewhere. Results: We identified 263 nonpalpable testes in 225 patients between September 1992 and 1996. In 40 patients 46 testes (18{\%}) were found during physical examination under anesthesia. Of the remaining cases considered appropriate for laparoscopy 215 with complete records were further analyzed. Only 12.6{\%} could be considered missed on examination due to a viable testis distal to the inguinal ring. Of the testes 45.7{\%} would have been found during inguinal exploration alone. In 9.8{\%} of the patients there were intra-abdominal vanishing testes, while 4.2{\%} had indeterminate cord structures on inguinal exploration that would have prompted abdominal extension without a laparoscopic demonstration that the vas and vessels entered the canal. A conventional inguinal incision would have provided optimal exposure for operative management in 34{\%} of the testes. For testes distal to the internal ring when the vas and vessels were distinctly atretic we never identified a viable testis, while a normal appearing vas and vessel were associated with a 45{\%} chance of a salvageable testis. Laparoscopy was informative regarding testis position in all cases in which it was performed. Conclusions: In 13.2{\%} of the cases laparoscopic findings precluded unnecessary abdominal exploration. The typical surgical incision for inguinal exploration would have left the surgeon compromised in 66{\%} of the cases compared to the approach optimized as a result of laparoscopic testicular localization. Of the patients 34{\%} arguably did not benefit from laparoscopy versus inguinal exploration. A simple examination under anesthesia significantly decreases the number of uninformative laparoscopic evaluations, and it is well worth the cost of a few minutes of operative time.",
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