Iranian Journal of Pediatric Surgery

Vol. 11 No. 2 (2025)

Laparoscopic Approach to Impalpable Undescended Testes: A Single-Centre Evaluation Laparoscopic Approach to Impalpable Undescended Testes

Iranian Journal of Pediatric Surgery, Vol. 11 No. 2 (2025), 26 October 2025 , Page 207 - 219
https://doi.org/10.22037/irjps.v11i2.48491

Abstract

Introduction: Undescended testes (UDT) is the congenital anomaly affecting children and is one of the most common anomaly. The failure of the testes either unilateral or bilateral to reach the processus vaginalis or scrotum 10-12 weeks after birth is termed as undescended testes or cryptorchidism. Impalpable undescended testes presents diagnostic and management challenges in the pediatric population.     

AIM: Evaluating the role of laparoscopy in managing impalpable undescended testes.

Materials and methods: The observational prospective study, conducted in the Department of General Surgery between January 2021 and December 2023. Patients who complained of absent or impalpable testes were clinically assessed and those with impalpable testes were included. Depending on the findings of diagnostic laparoscopy, testes were either brought down to the scrotum in the single- or two-staged procedure (Stephen Fowler) or removed.

Results: 25 patients with impalpable undescended testes were included, and 28 procedures were performed. Of the 25 patients, 14 had right-sided UDT, eight had left-sided UDT, and three had bilateral UDT. All the patients underwent diagnostic laparoscopy. Fourteen (50%) had high intra-abdominal testes, 10(35.7%) had low intra-abdominal testes, 3(10.7%) entered the deep ring with vas and vessels, and one patient had nubbin testis. Fifteen patients underwent single-stage laparoscopic orchidopexy, 7patients underwent two-staged procedures, three patients had vas and vessels entering the deep ring and underwent open inguinal orchidopexy, while three patients underwent orchidectomy.

Conclusion: Ultrasonography (USG) and magnetic resonance imaging (MRI), are the imaging modalities which play a crucial role in localization of impalpable testes. However, laparoscopy provides the most accurate interventional option by demonstrating anatomy. 

Keywords:
  • Cryptorchidism
  • Impalpable undescended testes
  • Orchidopexy
  • Orchidectomy
  • Examination under anesthesia (EUA)
  • Laparoscopy

How to Cite

Wani, A. H., Singh, G., Rayoo, S., & Arya, N. (2025). Laparoscopic Approach to Impalpable Undescended Testes: A Single-Centre Evaluation: Laparoscopic Approach to Impalpable Undescended Testes. Iranian Journal of Pediatric Surgery, 11(2), 207–219. https://doi.org/10.22037/irjps.v11i2.48491

References

1. Acderini CL, Miles HL, Dunger DB, Ong KK, Hughes IA. The descriptive epidemiology of congenital and acquired cryptorchidism in a UK infant cohort. Arch Dis Child. 2009;94: 868-72.

2. Cobellis G, Noviello C, Nino F, et al. Spermatogenesis and cryptorchidism. Front Endocrinol (Lausanne) 2012; 5:63.

3. Jensen MS, Toft G, Thulstrup AM, Henriksen TB, Olsen J, Christensen K, et al. Cryptorchidism concordance in monozygotic and dizygotic twin brothers, full brothers, and half-brothers. Fertil Steril. 2010; 93:124-9.

4. Kirsch AJ, Escala J, Duckett JW, Smith GH, Zderic SA, Canning DA, et al. Surgical management of the nonpalpable testis: The children’s Hospital of Philadelphia experience. J Urol. 1998; 159:1340-3.

5. Moore RG, Peters CA, Bauer SB, Mandell J, Retik AB. Laparoscopic evaluation of the nonpalpable testis-a prospective assessment of accuracy. J Urol. 1994; 151:728-31.

6. Tasian GE, Hittelman AB, Kim GE, DiSandro MJ, Baskin LS. Age at orchiopexy and testis palapability predict germ and leydig cell loss: Clinical predictors of adverse histlogical features of cryptorchidism. J Urol. 2009; 182:704-9.

7. Pettersson A, Richiardi L, Nordenskjold A, Kaijser M, Akre O. Age at surgery for undescended testis and risk of testicular cancer. N Engl J Med. 2007;356: 1835-41.

8. Docimo SG, Silver RI, Cromie W. The Undescended testicle: Diagnosis and management. Am Fam Physician. 2000; 62:2037-44.

9. Park KH, Lee JH, Han JJ, Lee SD, Song SY. Histological evidences suggest recommending orchiopexy within the first year of life for children with unilateral inguinal cryptorchid testis. Int J Urol. 2007; 14:616-21.

10. Patil KK, Gren JSA, Duffy PG. Laparoscopy for impalpable testis. BJU Int. 2005;95: 704-8.

11. Ostlie DJ, Gatti JM. The use of laparoscopy in the management of nonpalpable undescended testis. Curr Opin Pediatr. 2007; 19:349-53.

12. Elder JS. Laparoscopy for impalpable testes: Significance of the patent processus vaginalis. J Urol. 1994; 152:776-8.

13. Dar SA, Bali RS, Zahoor Y, Kema AR, Bhardwaj R. Undescended testes and laparoscopy: Experience from developing world. Adv Urol. 2018:1620470.

14. Ismail K, Ashour M, El-Afifi M, Hashish A. Laparoscopy in the management of impalpable testis. World J Surg. 2009;33(7):1514-9.

15. Hassan ME, Mustafawi A. Laparoscopic management of impalpable testes in children-new classification; lessons learned and rare anomalies. J Laparoendosc Adv Surg Tech. 2010;20(3):265-9.

16. Salah SEE, Ahmed EOE. The role of laparoscopy in nonpalpable undescended testiscle: Analysis and review of the experience from two cities in Sudan. Afr J Paediatr Surg. 2022;19(3):127-32.

17. El-Gohary MA. The role of laparoscopy in the management of impalpable testes. Pediatr Surg Int. 1997;12(5-6):463-5.

18. Humphery GME. Laparoscopy in the management of the impalpable undescended testis. Br J Surg. 1998;85(7):983-5.

19. Khan SA, Laghari AA, Abbasi MR, Bhatti S. Laparoscopic assisted management of impalpable testis in patients older than 10 years. JSLS. 2010;14(2):251-5.

20. Tsujihata M, Miyake O, Yoshimura K, Kakimoto K, Matsumiya K, Takahara S, et al. Laparoscopic diagnosis and treatment of nonpalpable testis. Int J Urol. 2001;8(12):692-6.

  • Abstract Viewed: 102 times
  • PDF Downloaded: 73 times

Download Statastics

Developed By

Open Journal Systems