IS LAPAROSCOPIC EXPLORATION AN IDEAL APPROACH TO TREAT IMPALPABLE TESTIS? A SINGLE CENTRE EXPERIENCE
Keywords:
undescended testis, laparoscopy, orchidopexyAbstract
Objective: To share our experience of management of Impalpable testis (IPT) by laparoscopic exploration and call
attention to its importance.
Material and Methods: This prospective observational study was conducted at paediatric surgery unit, Khyber Teaching
Hospital Peshawar-Pakistan, from July 2015 to January 2017. All patients labelled as non-palpable testis (IPT) on clinical
examination were subjected to Ultrasound for further confirmation. Laparoscopic exploration was done for all patients
IPT. Single stage orchidopexy done for low IPT and two stage orchidopexy done for high IPT. Inguinal exploration was
performed in cases where vas & vessels were found exiting the deep ring.
Results: laparoscopic exploration was done for 62 IPT testis on 40 patients with a mean age of presentation 4.62±2.83
years (max of 13 years and min 1 years). Patients with bilateral IPT 55% (22 out of 40) and unilateral IPT 45% (18 out
of 40). IPT on right side 55.5 %(10 out of 18) and IPT on left side 44.5 %(8 out of 18). Operative finding revealed 79%
patients having visible intraabdominal testis and 21% patients no testis found on laparoscopy. Visible intraabdominal
testis further analysed and showed 63.3%(31/49) truly intrabdominal testis, 28.6%(14/49) peeping testis, 8.1% (4/49)
canalicuar testis. 13 cases in which no intrabdominal testis were found showed blind ended vas 15.4%(2/13) and vas
& vessels exiting the deep ring 84.6%(11/13). Single stage orchidopexy performed in61.3 %(38/62), 2 stage Stephen
fowler orchidopexy (SFO) in 17.7% (11/62), laparoscopy followed by exploration in 21% (13/62). After six months
follow up, 34.6%(18/52) testis found in good scrotal position, 29% (15/52) in mid scrotal position, 23% base of the
penis(12/52), 13.4 %(7/52) atrophy.
Conclusion: Laparoscopic treatment of non palpable testis is safe and effective for all types of impalpable testis with
the advantage of diagnostic as well as therapeutic.
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