LAPAROSCOPY FOR THE IMPALPABLE TESTIS

Background Use of laparoscopy in the management of the impalpable test is remains controversial. Localization of the testis may help plan or obviate the need for groin exploration. This study reviews the need fo r inguinal exploration with respect to laparoscopic findings, particul arly of vas and vessels entering a closed deep inguinal ring. Method C ase notes of boys undergoing laparoscopy for undescended testes were r eviewed retrospectively. Results Of 86 impalpable testes, 32 were intr a-abdominal and ten were absent with intra-abdominal blind ending vas and vessels. In 17 instances the vas and vessels entered an open inter nal ring and in 26 a closed internal ring. In one boy neither vas, ves sels nor testis were visualized. Of the 26 impalpable testes with a cl osed internal ring, excision of testicular remnants in 18 revealed no histological testicular parenchyma, one boy had bilateral perineal ect opic testes missed clinically and six were not explored. Conclusion Th e laparoscopic finding of vas and vessels entering a closed deep ingui nal ring should prompt a careful examination for an ectopic testis. If a palpable testis can be ruled out, inguinal exploration is not neces sary, as viable testicular parenchyma is rarely found. Laparoscopy wou ld have avoided negative exploration in 42 per cent of impalpable test es in this series.