Background: The management of the impalpable undescended testis is controve
rsial. The study examines emerging trends in the management of this problem
.
Methods: Two groups of boys were treated consecutively and recorded prospec
tively from 1974 to 1984 and from 1990 to 1998 inclusive, A consistent poli
cy of using the preperitoneal approach for impalpable testis was adopted du
ring both time intervals but during the second study period examination und
er anaesthesia and diagnostic laparoscopy were introduced to ascertain test
icular presence and location.
Results: Some 919 boys were treated for cryptorchidism during the study per
iod. Ninety boys in the first group (23 per cent) underwent preperitoneal e
xplorations for impalpable testes. Anorchia was present in 18 and orchidect
omy was performed in two boys. Thirty boys in the later group (5 pet cent)
were diagnosed as having impalpable testes. Fifteen boys underwent successf
ul preperitoneal orchidopexy, anorchia was present in 11 and four underwent
orchidectomy, carried out for high intraabdominal testes.
Conclusion: Examination under anaesthesia and subsequent laparoscopic asses
sment for all impalpable testes has reduced the need for preperitoneal expl
oration for the impalpable undescended testis, In this large series, divisi
on of the testicular vessels in order to secure scrotal placement of the te
stis was required in one instance only.