Emerging trends in the management of the impalpable testis

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.