Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Pediatr. Nov 8, 2015; 4(4): 155-159
Published online Nov 8, 2015. doi: 10.5409/wjcp.v4.i4.155
Use of laparoscopy as the initial surgical approach of impalpable testes: 10-year experience
Kin Wai Edwin Chan, Kim Hung Lee, Hei Yi Vicky Wong, Siu Yan Bess Tsui, Yuen Shan Wong, Kit Yi Kristine Pang, Jennifer Wai Cheung Mou, Yuk Him Tam
Kin Wai Edwin Chan, Kim Hung Lee, Hei Yi Vicky Wong, Siu Yan Bess Tsui, Yuen Shan Wong, Kit Yi Kristine Pang, Jennifer Wai Cheung Mou, Yuk Him Tam, Division of Paediatric Surgery and Paediatric Urology, Department of Surgery, the Prince of Wales Hospital, the Chinese University of Hong Kong, Hong Kong, China
Author contributions: Chan KWE contributed to the study design, literature search, manuscript writing and final revision of the article; Wong HYV, Tsui SYB, Wong YS, Pang KYK and Mou JWC performed the research; Lee KH and Tam YH contributed to supervision.
Institutional review board statement: The study was reviewed and approved by the Joint CUHK-NTEC Clinical Research Ethics Committee (CREC) (CRE Ref. No. 2015.318).
Informed consent statement: As anonymized administrative and clinical data were used for this study, specific written consent was not required to use patient information stored in hospital databases.
Conflict-of-interest statement: The authors declare that there is no conflict of interest to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/ licenses/by-nc/4.0/
Correspondence to: Dr. Kin Wai Edwin Chan, MBChB, FRCSEd (Paed), FCSHK, FHKAM (Surgery), Division of Paediatric Surgery and Paediatric Urology, Department of Surgery, the Prince of Wales Hospital, the Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China. edwinchan@surgery.cuhk.edu.hk
Telephone: +852-26322953 Fax: +852-26324669
Received: May 8, 2015
Peer-review started: May 9, 2015
First decision: July 10, 2015
Revised: July 23, 2015
Accepted: August 13, 2015
Article in press: August 14, 2015
Published online: November 8, 2015
Processing time: 186 Days and 0.8 Hours
Abstract

AIM: To review the experience in the management of impalpable testes using laparoscopy as the initial approach and the need for inguinal exploration.

METHODS: From January 2004 to June 2014, 339 patients with undescended testes underwent operation in our institute. Fifty patients (15%) had impalpable testes. All children with impalpable testes underwent initial laparoscopy. A retrospective review was conducted on this group of patients and the outcome was analyzed.

RESULTS: Forty children had unilateral impalpable testis. Ten children had bilateral impalpable testes. Thirty-one children (78%) in the unilateral group underwent subsequent inguinal exploration while 4 children (40%) in the bilateral group underwent inguinal exploration (P < 0.05). Orchidopexy was performed in 16 children (40%) in the unilateral group and 9 children (90%) in the bilateral group (P < 0.05). Regarding the 24 children with unilateral impalpable testis and underwent orchidectomy for testicular nubbin (n = 19) or atrophic testes (n = 2) or has vanishing testes (n = 3); contralateral testicular hypertrophy was noticed in 10 (41%). No intra-operative complication was encountered. Two children after staged Fowler-Stephens procedure and 1 child after inguinal orchidopexy had atrophic testes.

CONCLUSION: The use of laparoscopy in children with impalpable testes is a safe procedure and can guide the need for subsequent inguinal exploration. Children with unilateral impalpable testis were associated with an increased need for inguinal exploration after laparoscopy. Orchidopexies could be performed successfully in 90% of children with bilateral impalpable testes.

Keywords: Laparoscopy; Impalpable; Testis; Inguinal

Core tip: Among over 300 children with undescended testis underwent operation, 15% of children had impalpable testis. The review studies the use of laparoscopy as the initial management of children with impalpable testes. Compared with children with bilateral impalpable testes, children with unilateral impalpable testis had an increased need for subsequent inguinal exploration and a lower incidence of successful orchidopexy. Laparoscopy is a safe procedure with no intra-operative complication encountered in this study.