Laparoscopic and Robotic Orchiopexy for the Impalpable Undescended Testicle

  • Ahmad Z. MohamedEmail author
  • Regina Norris
  • Francis X. Schneck
Part of the Current Clinical Urology book series (CCU)


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.


Undescended testis Intra-abdominal testicle Orchiopexy Orchiectomy Stephen–Fowler Non-palpable testicle Diagnostic laparoscopy Inguinal canal 

Supplementary material

Laparoscopic Orchiopexy for Impalpable Testis (34 MB)


  1. 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. 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.PubMedGoogle Scholar
  3. 3.
    Abeyaratne MR, Aherne WA, Scott JE. The vanishing testis. Lancet. 1969;2:822–4.PubMedCrossRefGoogle Scholar
  4. 4.
    Koff SA. Does compensatory testicular enlargement predict monorchism? J Urol. 1991;146:632–3.PubMedGoogle Scholar
  5. 5.
    Elder JS. Ultrasonography is unnecessary in evaluating boys with a nonpalpable testis. Pediatrics. 2002;110:748–51.PubMedCrossRefGoogle Scholar
  6. 6.
    Hrebinko RL, Bellinger MF. The limited role of imaging techniques in managing children with undescended testes. J Urol. 1993;150:458–60.PubMedGoogle Scholar
  7. 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.PubMedCrossRefGoogle Scholar
  8. 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.PubMedCrossRefGoogle Scholar
  9. 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.PubMedCrossRefGoogle Scholar
  10. 10.
    Docimo SG. Re: Is human chorionic gonadotropin useful for identifying and treating nonpalpable testis? J Urol. 2001;166:1010–1.PubMedCrossRefGoogle Scholar
  11. 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.PubMedCrossRefGoogle Scholar
  12. 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.PubMedCrossRefGoogle Scholar
  13. 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.PubMedGoogle Scholar
  14. 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.PubMedGoogle Scholar
  15. 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.PubMedCrossRefGoogle Scholar
  16. 16.
    Nagar H, Haddad R. Impact of early orchidopexy on testicular growth. Br J Urol. 1997;80:334–5.PubMedCrossRefGoogle Scholar
  17. 17.
    Lee PA, Coughlin MT. Leydig cell function after cryptorchidism: evidence of the beneficial result of early surgery. J Urol. 2002;167:1824–7.PubMedCrossRefGoogle Scholar
  18. 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.PubMedCrossRefGoogle Scholar
  19. 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.PubMedCrossRefGoogle Scholar
  20. 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. 21.
    Jones PF, Bagley FH. An abdominal extraperitoneal approach for the difficult orchidopexy. Br J Surg. 1979;66:14–8.PubMedCrossRefGoogle Scholar
  22. 22.
    Corkery JJ. Staged orchiopexy – a new technique. J Pediatr Surg. 1975;10:515–8.PubMedCrossRefGoogle Scholar
  23. 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.CrossRefGoogle Scholar
  24. 24.
    Silber SJ, Kelly J. Successful autotransplantation of an intra-abdominal testis to the scrotum by microvascular technique. J Urol. 1976;115:452–4.PubMedGoogle Scholar
  25. 25.
    Docimo SG. The results of surgical therapy for cryptorchidism: a literature review and analysis. J Urol. 1995;154:1148–52.PubMedCrossRefGoogle Scholar
  26. 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.PubMedCrossRefGoogle Scholar
  27. 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.PubMedCrossRefGoogle Scholar
  28. 28.
    Perovic S, Janic N. Laparoscopy in the diagnosis of non-palpable testes. Br J Urol. 1994;73:310–3.PubMedCrossRefGoogle Scholar
  29. 29.
    Lakhoo K, Thomas DF, Najmaldin AS. Is inguinal exploration for the impalpable testis an outdated operation? Br J Urol. 1996;77:452–4.PubMedCrossRefGoogle Scholar
  30. 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.PubMedCrossRefGoogle Scholar
  31. 31.
    Baker LA, Docimo SG, Surer I, et al. A multi-institutional analysis of laparoscopic orchidopexy. BJU Int. 2001;87:484–9.PubMedCrossRefGoogle Scholar
  32. 32.
    Koyle MA, Rajfer J, Ehrlich RM. The undescended testis. Pediatr Ann. 1988;17(39):42–6.Google Scholar
  33. 33.
    Galvin DJ, Bredin H. The role of laparoscopy in the management of the impalpable testicle. Ir J Med Sci. 2002;171:73–5.PubMedCrossRefGoogle Scholar
  34. 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.PubMedCrossRefGoogle Scholar
  35. 35.
    Alam S, Radhakrishnan J. Laparoscopy for nonpalpable testes. J Pediatr Surg. 2003;38:1534–6.PubMedCrossRefGoogle Scholar
  36. 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.PubMedCrossRefGoogle Scholar
  37. 37.
    Rodriguez A, Freire U, Orpez R, Lorenzo G. Diagnostic and therapeutic laparoscopy for nonpalpable testis. Surg Endosc. 2003;17:1756–8.CrossRefGoogle Scholar
  38. 38.
    Castilho LN, Ferreira U. Laparoscopy in adults and children with nonpalpable testes. Andrologia. 1987;19:539–43.PubMedCrossRefGoogle Scholar
  39. 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.PubMedCrossRefGoogle Scholar
  40. 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.PubMedCrossRefGoogle Scholar
  41. 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.PubMedCrossRefGoogle Scholar
  42. 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.PubMedCrossRefGoogle Scholar
  43. 43.
    Lindgren BW, Darby EC, Faiella L, et al. Laparoscopic orchiopexy: procedure of choice for the nonpalpable testis? J Urol. 1998;159:2132–5.PubMedCrossRefGoogle Scholar
  44. 44.
    Gill IS, Ross JH, Sung GT, Kay R. Needlescopic surgery for cryptorchidism: the initial series. J Pediatr Surg. 2000;35:1426–30.PubMedCrossRefGoogle Scholar
  45. 45.
    Merguerian PA, Mevorach RA, Shortliffe LD, Cendron M. Laparoscopy for the evaluation and management of the nonpalpable testicle. Urology. 1998;51:3–6.PubMedCrossRefGoogle Scholar
  46. 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.PubMedCrossRefGoogle Scholar
  47. 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.PubMedCrossRefGoogle Scholar
  48. 48.
    Jordan GH, Winslow BH. Laparoscopic single stage and staged orchiopexy. J Urol. 1994;152:1249–52.PubMedGoogle Scholar
  49. 49.
    Bloom DA. Two-step orchiopexy with pelviscopic clip ligation of the spermatic vessels. J Urol. 1991;145:1030–3.PubMedGoogle Scholar
  50. 50.
    Caldamone AA, Amaral JF. Laparoscopic stage 2 Fowler–Stephens orchiopexy. J Urol. 1994;152:1253–6.PubMedGoogle Scholar
  51. 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.PubMedCrossRefGoogle Scholar
  52. 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.PubMedCrossRefGoogle Scholar
  53. 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.PubMedCrossRefGoogle Scholar
  54. 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.PubMedCrossRefGoogle Scholar
  55. 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.PubMedCrossRefGoogle Scholar
  56. 56.
    Abolyosr A. Laparoscopic versus open orchiopexy in the management of abdominal testis: a descriptive study. Int J Urol. 2006;13:1421–4.PubMedCrossRefGoogle Scholar
  57. 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.PubMedCrossRefGoogle Scholar
  58. 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.PubMedGoogle Scholar
  59. 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.PubMedCrossRefGoogle Scholar
  60. 60.
    Hurwitz RS, Kaptein JS. How well does contralateral testis hypertrophy predict the absence of the nonpalpable testis? J Urol. 2001;165:588–92.PubMedCrossRefGoogle Scholar
  61. 61.
    Docimo SG. Re: experience with the Bailez technique for laparoscopic access in children. J Urol. 2004;171:806.PubMedCrossRefGoogle Scholar
  62. 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.PubMedCrossRefGoogle Scholar
  63. 63.
    Schulam PG, Hedican SP, Docimo SG. Radially dilating trocar system for open laparoscopic access. Urology. 1999;54:727–9.PubMedCrossRefGoogle Scholar
  64. 64.
    Bellinger MF. The blind-ending vas: the fate of the contralateral testis. J Urol. 1985;133:644–5.PubMedGoogle Scholar
  65. 65.
    Elder JS. Laparoscopy for impalpable testes: significance of the patent processus vaginalis. J Urol. 1994;152:776–8.PubMedGoogle Scholar
  66. 66.
    King LR. Orchiopexy for impalpable testis: high spermatic vessel division is a safe maneuver. J Urol. 1998;160:2457–60.PubMedCrossRefGoogle Scholar
  67. 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.PubMedCrossRefGoogle Scholar
  68. 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.PubMedGoogle Scholar
  69. 69.
    Peters CA. Complications in pediatric urological laparoscopy: results of a survey. J Urol. 1996;155:1070–3.PubMedCrossRefGoogle Scholar
  70. 70.
    Jordan GH. Laparoscopic management of the undescended testicle. Urol Clin North Am. 2001;28: 23–9.PubMedCrossRefGoogle Scholar
  71. 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.PubMedCrossRefGoogle Scholar
  72. 72.
    Yee DS, Duel BP. Omental herniation through a 3-mm umbilical trocar site. J Endourol. 2006;20:133–4.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Ahmad Z. Mohamed
    • 1
    Email author
  • Regina Norris
    • 2
  • Francis X. Schneck
    • 2
  1. 1.Department of UrologyChildren’s Hospital of Pittsburgh of UPMCPittsburghUSA
  2. 2.Division of Pediatric UrologyChildren’s Hospital of Pittsburgh of UPMCPittsburghUSA

Personalised recommendations