Video laparoscopic evaluation of the nonpalpable testis: 36 consecutive explorations in 16 months

Thirty-three children with a nonpalpable testis (NPT) were evaluated at our institution. Two babies had bilateral cryptorchidism with normal karyotype (46xy) and positive hormonal stimulation test, and one baby (46xy) had bilateral anorchia. The age range was 2-6 years. When ultrasonography and nuclear magnetic resonance cannot show the position of the NPT along the normal pathway, video laparoscopy is essential for diagnostic accuracy. Five cases were observed to have blind-ending vas deferens and testicular vessels; therefore, no other procedure was done. One had residual nonfunctional intra- abdominal tissue; in nine cases (one bilateral), an intra-abdominal testis was found, and seven microvascular and three traditional orchidopexies were performed; the remaining 18 patients (two bilaterals) had normal vas and spermatic vessels entering the inguinal canal. In six cases (one bilateral), a normal testis was present, and it was positioned into the scrotum with the standard technique; in 12 cases (one bilateral), an atrophic testis was found and was removed through an inguinal approach. Diagnostic laparoscopy permits not only localization of the testis but also planning for a better therapeutic program with a minimally invasive procedure, thus avoiding the knife in 17 % of cases.