The Role of Laparoscopy in the Localization and Management of Adult Impalpable Testes

BACKGROUND: Very few studies are available that describe the role of laparoscopy in adults with impalpable testes. This study compares laparoscopy with ultra-sonography in this subset of patients. METHODS: Fourteen adults, having a mean age of 21 years, with 19 undescended testes were evaluated. None of the testes was palpable, preoperative ultrasound localized 7 testes (36.8%), but a change in findings was observed in 3 of these cases (42.8%) on subsequent laparoscopy. On laparoscopy, 18 (94.7%) of the testes were localized as intraabdominal. The remaining patient had a case of true anorchia. Seven patients with unilateral undescended testes underwent laparoscopic orchiectomy, and 2 patients with unilateral undescended testes and all the patients with bilateral undescended testes underwent laparoscopic-assisted orchiopexy. No complication was noted in any of the cases. Hernia, present in 4 patients, was simultaneously repaired laparoscopically. CONCLUSION: Laparoscopy is a safe and effective modality in the localization and management of adult undescended testes. In adults, orchiectomy with the subsequent reduction in the risk of malignancy is the major issue of concern. Also, the repair of concomitant hernias is desirable. Both of these procedures can be done laparoscopically in the same sitting without the need for inguinal exploration.