Diagnostic of non-palpable testis in children: laparoscopy or magnetic resonance imaging?

Laparoscopy and magnetic resonance imaging (MRI) are competetive tools in t he diagnostic of non-palpable testis. Advantages and disadvantages of this methods will be demonstrate. 29 boys investigated for this indication with MRI. In case MRI failed to locate the testis laparoscopy was performed with a new miniaturized set of pediatric instruments (1.9 mm optic). The aim of laparoscopy was the identification of the spermatic duct and vessels and t heir topographic relation to the internal inguinal ring. All findings were verified by open surgical procedures. MRI revealed 10 inguinal and 7 abdomi nal testis. There was no false positive finding. In 12 boys MRI showed no t estis. 4 cases were correct negative, 8 cases were false negative (32%). In these 8 MRI-negative patients laparoscopy revealed 7 inguinal and 1 abdomi nal testis. The optical quality of the mini-telescope was sufficient for a 100% correct diagnosis. Laparoscopy related complications did not occur. La paroscopy proved to be a powerful low risk diagnostic method in non-palpabl e testis with high sensitivity and specifity (100% correct positive, 0% fal se negative). Therefore lapraroscopy is recommended as primary diagnostic a ccess for this indication. In the same anesthesia a optimal therapy is poss ible. Nevertheless a positive MRI-finding locates the testis reliably, wher eas a negative finding always needs further exploration because testis migh t have been missed.