Skip to main content

Laparoscopic and Robotic Orchiopexy for the Impalpable Undescended Testicle

  • Chapter
  • First Online:
Robotic and Laparoscopic Reconstructive Surgery in Children and Adults

Part of the book series: Current Clinical Urology ((CCU))

  • 800 Accesses

Abstract

Approximately 1% of males are diagnosed with cryptorchidism [1]. In the majority of cases the undescended testicle is palpable. However, as many as 20% of cryptorchid patients will have a non-palpable testis [2]. In these cases, the testis might be absent, intra-abdominal, or within the inguinal canal (canalicular). Prior to the advent of laparoscopic exploration for the non-palpable testicle in 1976, management of the undescended testicle consisted of an inguinal exploration with extension into the peritoneum [3]. The testicle was either absent (vanishing), removed, positioned scrotally, or in the worst case scenario, not located by the surgeon.

This chapter contains a video segment which can be found at the URL: http://www.springerimages.com/ost

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. John Radcliffe Hospital Cryptorchidism Study Group. Cryptorchidism: a prospective study of 7500 consecutive male births, 1984–8. Arch Dis Child. 1992;67:892–9.

    Google Scholar 

  2. Cendron M, Huff DS, Keating MA, Snyder HM 3rd, Duckett JW. Anatomical, morphological and volumetric analysis: a review of 759 cases of testicular maldescent. J Urol. 1993;149:570–3.

    PubMed  CAS  Google Scholar 

  3. Abeyaratne MR, Aherne WA, Scott JE. The vanishing testis. Lancet. 1969;2:822–4.

    Article  PubMed  CAS  Google Scholar 

  4. Koff SA. Does compensatory testicular enlargement predict monorchism? J Urol. 1991;146:632–3.

    PubMed  CAS  Google Scholar 

  5. Elder JS. Ultrasonography is unnecessary in evaluating boys with a nonpalpable testis. Pediatrics. 2002;110:748–51.

    Article  PubMed  Google Scholar 

  6. Hrebinko RL, Bellinger MF. The limited role of imaging techniques in managing children with undescended testes. J Urol. 1993;150:458–60.

    PubMed  CAS  Google Scholar 

  7. Kanemoto K, Hayashi Y, Kojima Y, Maruyama T, Ito M, Kohri K. Accuracy of ultrasonography and magnetic resonance imaging in the diagnosis of non-palpable testis. Int J Urol. 2005;12:668–72.

    Article  PubMed  Google Scholar 

  8. Cisek LJ, Peters CA, Atala A, Bauer SB, Diamond DA, Retik AB. Current findings in diagnostic laparoscopic evaluation of the nonpalpable testis. J Urol. 1998;160:1145–9; discussion 50.

    Article  PubMed  CAS  Google Scholar 

  9. Polascik TJ, Chan-Tack KM, Jeffs RD, Gearhart JP. Reappraisal of the role of human chorionic gonadotropin in the diagnosis and treatment of the nonpalpable testis: a 10-year experience. J Urol. 1996;156:804–6.

    Article  PubMed  CAS  Google Scholar 

  10. Docimo SG. Re: Is human chorionic gonadotropin useful for identifying and treating nonpalpable testis? J Urol. 2001;166:1010–1.

    Article  PubMed  CAS  Google Scholar 

  11. Henna MR, Del Nero RG, Sampaio CZ, Atallah AN, Schettini ST, Castro AA, Soares BG. Hormonal cryptorchidism therapy: systematic review with meta-analysis of randomized clinical trials. Pediatr Surg Int. May 2004;20(5):357–9.

    Article  PubMed  Google Scholar 

  12. Hadziselimovic F. Successful treatment of unilateral cryptorchid boys risking infertility with LH–RH analogue. Int Braz J Urol. May–Jun 2008;34(3):319–26; discussion 27–8.

    Article  PubMed  Google Scholar 

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

    PubMed  CAS  Google Scholar 

  14. Tennenbaum SY, Lerner SE, McAleer IM, Packer MG, Scherz HC, Kaplan GW. Preoperative laparoscopic localization of the nonpalpable testis: a critical analysis of a 10-year experience. J Urol. 1994;151:732–4.

    PubMed  CAS  Google Scholar 

  15. Huff DS, Hadziselimovic F, Snyder HM 3rd, Blythe B, Ducket JW. Histologic maldevelopment of unilaterally cryptorchid testes and their descended partners. Eur J Pediatr. 1993;152(Suppl 2):S11–4.

    Article  PubMed  Google Scholar 

  16. Nagar H, Haddad R. Impact of early orchidopexy on testicular growth. Br J Urol. 1997;80:334–5.

    Article  PubMed  CAS  Google Scholar 

  17. Lee PA, Coughlin MT. Leydig cell function after cryptorchidism: evidence of the beneficial result of early surgery. J Urol. 2002;167:1824–7.

    Article  PubMed  Google Scholar 

  18. Rogers E, Teahan S, Gallagher H, et al. The role of orchiectomy in the management of postpubertal cryptorchidism. J Urol. 1998;159:851–4.

    Article  PubMed  CAS  Google Scholar 

  19. Oh J, Landman J, Evers A, Yan Y, Kibel AS. Management of the postpubertal patient with cryptorchidism: an updated analysis. J Urol. 2002;167:1329–33.

    Article  PubMed  Google Scholar 

  20. Howards SS. Surgery of the scrotum and testis in childhood. In: Walsh PC, Retik AB, Stamey T, Vaughn ED, editors. Campbell’s Urology. 6th ed. Philadelphia, PA: WB Saunders; 1992.

    Google Scholar 

  21. Jones PF, Bagley FH. An abdominal extraperitoneal approach for the difficult orchidopexy. Br J Surg. 1979;66:14–8.

    Article  PubMed  CAS  Google Scholar 

  22. Corkery JJ. Staged orchiopexy – a new technique. J Pediatr Surg. 1975;10:515–8.

    Article  PubMed  CAS  Google Scholar 

  23. Ransley PC, Vordermark JS, Caldamone AA, Bellinger MF. Preliminary ligation of the gonadal vessels prior to orchiopexy for the intra-abdominal testicle: a staged Fowler–Stephens procedure. World J Urol. 1984;2:266.

    Article  Google Scholar 

  24. Silber SJ, Kelly J. Successful autotransplantation of an intra-abdominal testis to the scrotum by microvascular technique. J Urol. 1976;115:452–4.

    PubMed  CAS  Google Scholar 

  25. Docimo SG. The results of surgical therapy for cryptorchidism: a literature review and analysis. J Urol. 1995;154:1148–52.

    Article  PubMed  CAS  Google Scholar 

  26. Cortesi N, Ferrari P, Zambarda E, Manenti A, Baldini A, Morano FP. Diagnosis of bilateral abdominal cryptorchidism by laparoscopy. Endoscopy. 1976;8:33–4.

    Article  PubMed  CAS  Google Scholar 

  27. Boddy SA, Corkery JJ, Gornall P. The place of laparoscopy in the management of the impalpable testis. Br J Surg. 1985;72:918–9.

    Article  PubMed  CAS  Google Scholar 

  28. Perovic S, Janic N. Laparoscopy in the diagnosis of non-palpable testes. Br J Urol. 1994;73:310–3.

    Article  PubMed  CAS  Google Scholar 

  29. Lakhoo K, Thomas DF, Najmaldin AS. Is inguinal exploration for the impalpable testis an outdated operation? Br J Urol. 1996;77:452–4.

    Article  PubMed  CAS  Google Scholar 

  30. Barqawi AZ, Blyth B, Jordan GH, Ehrlich RM, Koyle MA. Role of laparoscopy in patients with previous negative exploration for impalpable testis. Urology. 2003;61:1234–7; discussion 7.

    Article  PubMed  Google Scholar 

  31. Baker LA, Docimo SG, Surer I, et al. A multi-institutional analysis of laparoscopic orchidopexy. BJU Int. 2001;87:484–9.

    Article  PubMed  CAS  Google Scholar 

  32. Koyle MA, Rajfer J, Ehrlich RM. The undescended testis. Pediatr Ann. 1988;17(39):42–6.

    Google Scholar 

  33. Galvin DJ, Bredin H. The role of laparoscopy in the management of the impalpable testicle. Ir J Med Sci. 2002;171:73–5.

    Article  PubMed  CAS  Google Scholar 

  34. Esposito C, Damiano R, Gonzalez Sabin MA, et al. Laparoscopy-assisted orchidopexy: an ideal treatment for children with intra-abdominal testes. J Endourol. 2002;16:659–62.

    Article  PubMed  Google Scholar 

  35. Alam S, Radhakrishnan J. Laparoscopy for nonpalpable testes. J Pediatr Surg. 2003;38:1534–6.

    Article  PubMed  Google Scholar 

  36. Radmayr C, Oswald J, Schwentner C, Neururer R, Peschel R, Bartsch G. Long-term outcome of laparoscopically managed nonpalpable testes. J Urol. 2003;170:2409–11.

    Article  PubMed  Google Scholar 

  37. Rodriguez A, Freire U, Orpez R, Lorenzo G. Diagnostic and therapeutic laparoscopy for nonpalpable testis. Surg Endosc. 2003;17:1756–8.

    Article  Google Scholar 

  38. Castilho LN, Ferreira U. Laparoscopy in adults and children with nonpalpable testes. Andrologia. 1987;19:539–43.

    Article  PubMed  CAS  Google Scholar 

  39. Kanemoto K, Hayashi Y, Kojima Y, Tozawa K, Mogami T, Kohri K. The management of nonpalpable testis with combined groin exploration and subsequent transinguinal laparoscopy. J Urol. 2002;167:674–6.

    Article  PubMed  Google Scholar 

  40. Belman AB, Rushton HG. Is an empty left hemiscrotum and hypertrophied right descended testis predictive of perinatal torsion? J Urol. 2003;170:1674–5; discussion 5–6.

    Article  PubMed  Google Scholar 

  41. Schleef J, von Bismarck S, Burmucic K, Gutmann A, Mayr J. Groin exploration for nonpalpable testes: laparoscopic approach. J Pediatr Surg. 2002;37:1552–5.

    Article  PubMed  CAS  Google Scholar 

  42. Stec AA, Tanaka ST, Adams MC, Pope JC 4th, Thomas JC, Brock JW 3rd. Orchiopexy for intra-abdominal testes: factors predicting success. J Urol. Oct 2009;182(4 Suppl):1917–20.

    Article  PubMed  Google Scholar 

  43. Lindgren BW, Darby EC, Faiella L, et al. Laparoscopic orchiopexy: procedure of choice for the nonpalpable testis? J Urol. 1998;159:2132–5.

    Article  PubMed  CAS  Google Scholar 

  44. Gill IS, Ross JH, Sung GT, Kay R. Needlescopic surgery for cryptorchidism: the initial series. J Pediatr Surg. 2000;35:1426–30.

    Article  PubMed  CAS  Google Scholar 

  45. Merguerian PA, Mevorach RA, Shortliffe LD, Cendron M. Laparoscopy for the evaluation and management of the nonpalpable testicle. Urology. 1998;51:3–6.

    Article  PubMed  CAS  Google Scholar 

  46. Lindgren BW, Franco I, Blick S, et al. Laparoscopic Fowler–Stephens orchiopexy for the high abdominal testis. J Urol. 1999;162:990–3; discussion 4.

    Article  PubMed  CAS  Google Scholar 

  47. Docimo SG, Moore RG, Adams J, Kavoussi LR. Laparoscopic orchiopexy for the high palpable undescended testis: preliminary experience. J Urol. 1995;154:1513–5.

    Article  PubMed  CAS  Google Scholar 

  48. Jordan GH, Winslow BH. Laparoscopic single stage and staged orchiopexy. J Urol. 1994;152:1249–52.

    PubMed  CAS  Google Scholar 

  49. Bloom DA. Two-step orchiopexy with pelviscopic clip ligation of the spermatic vessels. J Urol. 1991;145:1030–3.

    PubMed  CAS  Google Scholar 

  50. Caldamone AA, Amaral JF. Laparoscopic stage 2 Fowler–Stephens orchiopexy. J Urol. 1994;152:1253–6.

    PubMed  CAS  Google Scholar 

  51. Samadi AA, Palmer LS, Franco I. Laparoscopic orchiopexy: report of 203 cases with review of diagnosis, operative technique, and lessons learned. J Endourol. 2003;17:365–8.

    Article  PubMed  Google Scholar 

  52. El-Anany F, Gad El-Moula M, Abdel Moneim A, et al. Laparoscopy for impalpable testis: classification-based management. Surg Endosc. Mar 2007;21(3):449–54.

    Article  PubMed  CAS  Google Scholar 

  53. Kirsch AJ, Escala J, Duckett JW, et al. Surgical management of the nonpalpable testis: the Children’s Hospital of Philadelphia experience. J Urol. 1998;159:1340–3.

    Article  PubMed  CAS  Google Scholar 

  54. Dhanani NN, Cornelius D, Gunes A, Ritchey ML. Successful outpatient management of the nonpalpable intra-abdominal testis with staged Fowler–Stephens orchiopexy. J Urol. 2004;172:2399–401.

    Article  PubMed  Google Scholar 

  55. Ferro F, Spagnoli A, Zaccara A, De Vico A, La Sala E. Is preoperative laparoscopy useful for impalpable testis? J Urol. 1999;162:995–6; discussion 7.

    Article  PubMed  CAS  Google Scholar 

  56. Abolyosr A. Laparoscopic versus open orchiopexy in the management of abdominal testis: a descriptive study. Int J Urol. 2006;13:1421–4.

    Article  PubMed  Google Scholar 

  57. Lorenzo AJ, Samuelson ML, Docimo SG, Baker LA, Lotan Y. Cost analysis of laparoscopic versus open orchiopexy in the management of unilateral nonpalpable testicles. J Urol. 2004;172:712–6.

    Article  PubMed  Google Scholar 

  58. Banieghbal B, Davies M. Laparoscopic evaluation of testicular mobility as a guide to management of intra-abdominal testes. World J Urol. 2003;20:343–5.

    PubMed  CAS  Google Scholar 

  59. Tackett LD, Wacksman J, Billmire D, Sheldon CA, Minevich E. The high intra-abdominal testis: technique and long-term success of laparoscopic testicular autotransplantation. J Endourol. 2002;16:359–61.

    Article  PubMed  Google Scholar 

  60. Hurwitz RS, Kaptein JS. How well does contralateral testis hypertrophy predict the absence of the nonpalpable testis? J Urol. 2001;165:588–92.

    Article  PubMed  CAS  Google Scholar 

  61. Docimo SG. Re: experience with the Bailez technique for laparoscopic access in children. J Urol. 2004;171:806.

    Article  PubMed  Google Scholar 

  62. Cuellar DC, Kavoussi PK, Baker LA, Docimo SG. Open laparoscopic access using a radially dilating trocar: experience and indications in 50 consecutive cases. J Endourol. 2000;14:755–6.

    Article  PubMed  CAS  Google Scholar 

  63. Schulam PG, Hedican SP, Docimo SG. Radially dilating trocar system for open laparoscopic access. Urology. 1999;54:727–9.

    Article  PubMed  CAS  Google Scholar 

  64. Bellinger MF. The blind-ending vas: the fate of the contralateral testis. J Urol. 1985;133:644–5.

    PubMed  CAS  Google Scholar 

  65. Elder JS. Laparoscopy for impalpable testes: significance of the patent processus vaginalis. J Urol. 1994;152:776–8.

    PubMed  CAS  Google Scholar 

  66. King LR. Orchiopexy for impalpable testis: high spermatic vessel division is a safe maneuver. J Urol. 1998;160:2457–60.

    Article  PubMed  CAS  Google Scholar 

  67. Ferrer FA, Cadeddu JA, Schulam P, Mathews R, Docimo SG. Orchiopexy using 2 mm laparoscopic instruments: 2 techniques for delivering the testis into the scrotum. J Urol. 2000;164:160–1.

    Article  PubMed  CAS  Google Scholar 

  68. Jarow JP, Berkovitz GD, Migeon CJ, Gearhart JP, Walsh PC. Elevation of serum gonadotropins establishes the diagnosis of anorchism in prepubertal boys with bilateral cryptorchidism. J Urol. 1986;136:277–9.

    PubMed  CAS  Google Scholar 

  69. Peters CA. Complications in pediatric urological laparoscopy: results of a survey. J Urol. 1996;155:1070–3.

    Article  PubMed  CAS  Google Scholar 

  70. Jordan GH. Laparoscopic management of the undescended testicle. Urol Clin North Am. 2001;28: 23–9.

    Article  PubMed  CAS  Google Scholar 

  71. Esposito C, Lima M, Mattioli G, et al. Complications of pediatric urological laparoscopy: mistakes and risks. J Urol. 2003;169:1490–2; discussion 1492.

    Article  PubMed  Google Scholar 

  72. Yee DS, Duel BP. Omental herniation through a 3-mm umbilical trocar site. J Endourol. 2006;20:133–4.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ahmad Z. Mohamed .

Editor information

Editors and Affiliations

Electronic supplementary material

Below is the link to the electronic supplementary material.

Laparoscopic Orchiopexy for Impalpable Testis (34 MB)

Rights and permissions

Reprints and permissions

Copyright information

© 2011 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Mohamed, A.Z., Norris, R., Schneck, F.X. (2011). Laparoscopic and Robotic Orchiopexy for the Impalpable Undescended Testicle. In: Ost, M. (eds) Robotic and Laparoscopic Reconstructive Surgery in Children and Adults. Current Clinical Urology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-60327-914-7_16

Download citation

  • DOI: https://doi.org/10.1007/978-1-60327-914-7_16

  • Published:

  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-60327-913-0

  • Online ISBN: 978-1-60327-914-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics