Original Article
The value of finding a closed internal ring on laparoscopy in unilateral nonpalpable testis

https://doi.org/10.1016/j.jpedsurg.2012.09.032Get rights and content

Abstract

Purpose

There is an ongoing debate about whether initial laparoscopy is as efficient as initial extra-abdominal exploration for unilateral nonpalpable testis. The aim of this study was to clarify whether the finding of a closed internal ring on laparoscopy accurately predicts extra-abdominal findings in unilateral nonpalpable testis.

Methods

Both laparoscopy and subsequent extra-abdominal exploration were prospectively performed in consecutive patients with unilateral nonpalpable testis. Laparoscopic findings were reviewed with respect to the status of the vas deferens, spermatic vessels, and the appearance of the internal ring. Except for patients with an abdominal testis, all patients underwent subsequent open exploration regardless of the laparoscopic findings. Open explorations were primarily performed by scrotal incision. During open exploration, any testicular remnants were removed and evaluated histologically.

Results

A total of 100 patients with unilateral nonpalpable testis were evaluated, of whom 15 had an abdominal testis. Of the 85 patients without an abdominal testis, an open internal ring was recognized in only 8. Of the remaining 77 with a closed internal ring, subsequent open exploration revealed testicular nubbins in all patients (100%), regardless of the laparoscopic findings of the vessels and vas. Nine nubbins were associated with intra-abdominal vanishing vessels above the closed internal ring. All nubbins were confirmed by histological findings, and the incidence of viable germ cell elements was 7.4%.

Conclusions

When laparoscopy demonstrates no abdominal testis in patients with unilateral nonpalpable testis, the finding of a closed internal ring on laparoscopy is always associated with the presence of an extra-abdominal nubbin, regardless of the status of the vessels and the vas at the internal ring. Subsequent extra-abdominal exploration can be obviated in this circumstance if nubbin excisions are skipped. Initial diagnostic laparoscopy for unilateral nonpalpable testis provides not only the intra-abdominal findings, but also exact prediction of the extra-abdominal findings in patients with a closed internal ring.

Section snippets

Methods

Between February 2007 and January 2012, both laparoscopy and subsequent extra-abdominal exploration were prospectively performed in consecutive patients with unilateral NPT. Ethical approval was obtained for the study from the institutional review board. To avoid the bias of knowing the diagnostic imaging findings, unilateral NPT was diagnosed before any diagnostic imaging was done. Although most patients underwent ultrasonographic measurement of the contralateral descended testis, no cutoff

Results

During the study period, 101 patients with unilateral NPT were enrolled. These children were all patients seen with a unilateral NPT between February 2007 and January 2012 in our institution. One patient who did not have open exploration with laparoscopic findings of intra-abdominal vanishing vessels was excluded from the analysis. The remaining 100 patients were evaluated. With respect to the laterality of the NPT, 25 were on the right side, and 75 were on the left side. The mean patient age

Discussion

Laparoscopy is now widely performed in patients with NPT for both diagnostic and therapeutic procedures [1], [2], [3], [4], [5]. Although the value of laparoscopy for an abdominal testis is well recognized, there is ongoing debate about whether initial laparoscopy is as efficient as initial extra-abdominal exploration for unilateral NPT [7], [8], [9]. The majority of children with unilateral NPT have a testicular nubbin in the scrotum detected simply by scrotal exploration [10]. These nubbins

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