The use of laparoscopy in the management of the nonpalpable testis.

Fifty-eight children with a nonpalpable testis have been evaluated at our institution between 1988 and 1994. Laparoscopy was performed in these children to effect a treatment plan. The children range in age from 10 months to 14 years. Thirty patients had a nonpalpable left testis, 18 had a nonpalpable right testis, and 10 had bilateral nonpalpable testes. In 28 children, a testis was visualized. Two underwent laparoscopic orchiectomy and 26 underwent either a standard single stage procedure (11), a staged open procedure (3), or a laparoscopically assisted staged procedure (12). Attenuated vessels were seen in 26 patients and inguinal exploration revealed a viable testis in 6 patients and a testis remnant, which was removed, in 20 patients. Four patients had laparoscopic blind-ending vessels. Diagnostic laparoscopy affords the surgeon not only the ability to localize the testis with virtual certainty, but also the advantage of planning a highly successful treatment program. The position of the testis intra-abdominally and the length of the spermatic vessels can be easily evaluated to decide whether a staged approach versus a single stage procedure can be performed. The use of the KTP laser has made the two staged procedure quite easy with only one Trocar site necessary. This experience has allowed us to develop and modify an algorithm for the effective management of the nonpalpable testis.