Sonographic localization of nonpalpable testis: Tracking the cord technique

OBJECTIVE: To evaluate the value of USG as a diagnostic tool to locate nonpalpable testis (NPT), using a new technique of tracking the spermatic cord. MATERIALS AND METHODS: This technique was used in 197 instances of NPT over a period of 7 years. The presence or absence of the cord in the inguinal canal was recorded. The visualized spermatic cord was tracked down to the testis in extra-abdominal location. If spermatic cord was not visualized, the USG was extended up to look for intra-abdominal testis. The location and size of the testis were recorded, and the findings were compared with those seen at surgery. RESULTS: The status of NPT was predicted by sonography in 191 instances. The testis was canalicular in position in 53, abdominal in 76, ascending in 5, ectopic in 8, and moving in 5 cases. There were three instances of tumor in the NPT and one case of torsion. The testes were atrophic in 36 instances. The testis was not visualized by USG in 10 instances. In four of them, spermatic cord was seen in inguinal canal, indicating vanished testes. In one patient, there was an atrophic testis with inguinal hernia. Diagnostic laparoscopy was necessary in only five cases and showed abdominal testes in two cases and the cord entering the internal ring in three cases. There were one false-positive and four false-negative results with this technique. CONCLUSION: USG, with the tracking the cord technique, is a sensitive diagnostic tool in NPT. It is useful for selecting the ideal therapeutic surgical approach and helps avoid diagnostic laparoscopy in most of the patients.