Warren Snodgrass1, Kechi Chen, Clanton Harrison. 1. Division of Pediatric Urology, Children's Medical Center and The University of Texas Southwestern Medical Center, Dallas, Texas 75235, USA. warren.snodgrass@childrens.com
Abstract
PURPOSE: We investigated use of initial scrotal incision for the management of unilateral nonpalpable testis. MATERIALS AND METHODS: Scrotal incision followed by laparoscopy was performed in a consecutive series of 40 boys with unilateral impalpable testis. RESULTS: Initial scrotal incision revealed 22 scrotal nubbins and 4 extra-abdominal testes among the 40 patients. Of 13 patients with intra-abdominal testis 6 had a looping vas that was dissected to the internal ring via the scrotal incision, and the incision was used for orchiopexy in 12. Laparoscopy detected 1 case of intra-abdominal vanished testis but falsely diagnosed 6 additional cases based upon blind-ending vas and vessels despite a known scrotal nubbin. It also detected 13 intra-abdominal testes but was inconclusive in 14 cases in which vas and vessels exited the internal ring, not including the 4 patients with extra abdominal testes who did not undergo laparoscopy. CONCLUSIONS: Scrotal incision may be sufficient to diagnose testicular loss when a nubbin is encountered, and can detect an extra abdominal testis not palpated with the patient under anesthesia. The incision is used for orchiopexy in those patients with a testis that can be brought to the scrotum in a single stage. Laparoscopy potentially can be reserved for cases in which no nubbin is found and in all cases when a patent processus vaginalis is encountered.
PURPOSE: We investigated use of initial scrotal incision for the management of unilateral nonpalpable testis. MATERIALS AND METHODS: Scrotal incision followed by laparoscopy was performed in a consecutive series of 40 boys with unilateral impalpable testis. RESULTS: Initial scrotal incision revealed 22 scrotal nubbins and 4 extra-abdominal testes among the 40 patients. Of 13 patients with intra-abdominal testis 6 had a looping vas that was dissected to the internal ring via the scrotal incision, and the incision was used for orchiopexy in 12. Laparoscopy detected 1 case of intra-abdominal vanished testis but falsely diagnosed 6 additional cases based upon blind-ending vas and vessels despite a known scrotal nubbin. It also detected 13 intra-abdominal testes but was inconclusive in 14 cases in which vas and vessels exited the internal ring, not including the 4 patients with extra abdominal testes who did not undergo laparoscopy. CONCLUSIONS: Scrotal incision may be sufficient to diagnose testicular loss when a nubbin is encountered, and can detect an extra abdominal testis not palpated with the patient under anesthesia. The incision is used for orchiopexy in those patients with a testis that can be brought to the scrotum in a single stage. Laparoscopy potentially can be reserved for cases in which no nubbin is found and in all cases when a patent processus vaginalis is encountered.
Authors: Ramesh Mark Nataraja; Evie Yeap; Costa J Healy; Inderpal S Nandhra; Feilim L Murphy; John M Hutson; Chris Kimber Journal: Pediatr Surg Int Date: 2017-11-09 Impact factor: 1.827
Authors: Kin Wai Edwin Chan; Kim Hung Lee; Hei Yi Vicky Wong; Siu Yan Bess Tsui; Yuen Shan Wong; Kit Yi Kristine Pang; Jennifer Wai Cheung Mou; Yuk Him Tam Journal: World J Clin Pediatr Date: 2015-11-08