SCROTAL-INGUINAL ULTRASONOGRAPHY - A TECHNIQUE FOR IDENTIFYING THE NONPALPABLE INGUINAL TESTIS WITHOUT LAPAROSCOPY

Purpose: Treatment of the patient with a nonpalpable testis is controv ersial, since a high percent will have an inguinal testis or testicula r remnant at exploration. While laparoscopy is an effective modality f or localizing the intra-abdominal testis, diagnostic laparoscopy is of limited value for patients with nonpalpable (normal or atrophic) ingu inal testes. In an effort to identify preoperatively impalpable inguin al testes, we performed scrotal-inguinal ultrasound. Materials and Met hods: We evaluated 64 patients (74 nonpalpable testes) in the last 4 y ears, representing 20% of all those presenting with cryptorchidism. Av erage patient age was 4.5 years (range 6 months to 17 years). All pati ents underwent preoperative scrotal-inguinal ultrasound and surgical e xploration. Diagnostic laparoscopy was reserved for patients with nega tive ultrasound and no palpable tissue in the scrotum or groin on a pr eoperative examination. Results: Scrotal-inguinal ultrasound correctly identified 40 of the 42 inguinal testes (95% sensitivity), 7 of the 2 1 atrophic inguinal testes (33% sensitivity) and 1 of the 11 intra-abd ominal testes (9% sensitivity). Therefore, scrotal-inguinal ultrasound correctly identified an inguinal testis or remnant for 47 of the 74 n onpalpable testes (64%), eliminating the need for diagnostic laparosco py in those cases. For 26 of 74 nonpalpable testes with negative ultra sound 13 had an associated palpable inguinal or scrotal nubbin of tiss ue, and inguinal exploration only was performed, resulting in 9 orchie ctomies, 2 inguinal orchiopexies and 2, 2-stage orchiopexies. Of the 1 3 nonpalpable testes without palpable nubbins and negative scrotal-ing uinal ultrasound 8 were intra-abdominal and 5 were atrophic inguinal t estes. Conclusions: Scrotal-inguinal ultrasound identifies patients wi th nonpalpable testes who will maximally benefit from diagnostic lapar oscopy. When diagnostic laparoscopy was limited to nonpalpable testes without palpable nubbins and negative scrotal-inguinal ultrasound, onl y 13 of 74 (18%) required laparoscopy. Inguinal exploration without fu rther diagnostic studies is appropriate for boys with nonpalpable test es and palpable nubbins.