Avoidance of inguinal incision in laparoscopically confirmed vanishing testis syndrome

Purpose: Nonpalpable testicles may be due to the vanishing testis syndrome, intra-abdominal position, examination obscured by obesity or scar tissue a nd rarely testicular agenesis. Laparoscopy is an excellent means of disting uishing these entities without the need for open abdominal exploration. We investigated whether laparoscopy affects the need for an inguinal incision and exploration when no testicle is palpable and the vas and vas deferens a re visualized exiting the internal inguinal ring on laparoscopy. Materials and Methods: In 34 boys 6 to 18 months old (mean age 41) physical examination demonstrated a nonpalpable testicle, including on the right si de in 12, on the left side in 17 and bilaterally in 5. The vanishing testis syndrome was diagnosed after laparoscopy when no testicle was palpable des pite physical examination done with the patient under anesthesia, spermatic vessels were visualized exiting the internal inguinal ring or spermatic ve ssels were visualized in the abdomen with or without an identifiable intra- abdominal testicular nubbin. Results: Laparoscopy confirmed the vanishing testis syndrome in 16 patients , intra-abdominal testicles in 13 and peeping testes in 1. Adequate examina tion using anesthesia was not possible in 4 patients with obesity, or previ ous inguinal or lower abdominal surgery. These boys underwent inguinal expl oration after laparoscopy showed the vas and vessels exiting a closed inter nal inguinal ring. Of the 16 cases of the vanishing testis syndrome orchiec tomy with contralateral scrotal orchiopexy was performed in 14 through a me dian raphe scrotal incision and in I through an inguinal incision for an as sociated inguinal hernia. In the remaining patient who underwent laparoscop y only a blind ending vas and vessels were visualized in the abdomen withou t an identifiable nubbin. The infraumbilical and median raphe incisions hea led without obvious scars. Followup was at least I year. Conclusions: When spermatic vessels are visualized exiting the internal ing uinal ring on laparoscopy in the setting of a nonpalpable testicle, a media n raphe scrotal incision can be made to remove the testicular nubbin associ ated with the vanishing testicle syndrome. Orchiectomy is possible through this median raphe incision even when the testicle is in the inguinal canal because this distance in young children is small. Cosmesis is excellent sin ce 1 incision is within the umbilicus and the other is on the median scrota l raphe.