MANAGEMENT OF IMPALPABLE TESTES - INDICATIONS FOR ABDOMINAL EXPLORATION

Various approaches to the management of the impalpable testis in cases of cryptorchidism have been advocated. The authors' experience over t he past 13 years was reviewed to try to determine an optimal approach. Of 1,305 patients with undescended testicles seen between February 19 82 and December 1995, 157 boys (12.03%) had impalpable testes with 17 having bilateral impalpable testes for a total of 174 impalpable teste s, A hernia sac was present in 155 impalpable testes with a testicle p resent in all cases. No hernia sac was found in 19 impalpable testes, five of which had no testicle present, This was confirmed by either op en exploration or laparoscopy. One hundred forty-eight boys underwent groin exploration as initial treatment, 13 of these had bilateral impa lpable testes. In addition to the five absent testicles with no hernia sac, one patient with a hernia sac and no testicle evident benefited from Subsequent laparoscopy to identify an intraabdominal testicle. Al l other patients underwent routine orchidopexy or orchidectomy (one ca se with grossly malformed testicle), Nine boys underwent laparoscopy a s initial treatment, four of these had bilateral impalpable testes. Tw o abnormal testicles were found and removed, Groin exploration and sub sequent orchidopexy was definitive treatment in all other cases. The a ssociation of a hernia sac with an impalpable undescended testicle is very significant (P < .00001 Fisher's Exact test). The absence of a sa c therefore may reflect an alternate diagnosis. When no sac is found w ith a testicle in the groin, this may represent an ectopic testicle, W hen no sac is found with no testicle, this may represent a vanishing t esticle, From this experience the authors conclude that groin explorat ion should be the initial approach to impalpable testes, The presence of a hernia sac with an absent testicle demands further exploration; t he absence of a hernia sac with an absent testicle suggests a vanishin g testicle and may need no further exploration. Copyright (C) 1997 by W.B. Saunders Company.