Management of Boys With Nonpalpable Undescended Testis

Table 1.

Success Rates of Standard Open Orchidopexy for Intra-Abdominal Testis

Table 2.

Success Rates of One-Step Fowler-Stephens Orchidopexy for Intra-Abdominal Testis

Table 3.

Success Rates of Two-Step Fowler-Stephens Orchidopexy for Intra-Abdominal Testis

Table 4.

Success Rates of Laparoscopic-Assisted Orchidopexy for Intra-Abdominal Testis

Table 5.

Success Rates of Microvascular Autotransplantation Orchidopexy for Intra-Abdominal Testis

Bloom DA (1991) Two-step orchiopexy with pelviscopic clip ligation of the spermatic vessels. J Urol 145: 1030-1033
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Kirsch AJ et al. (1998) Surgical management of the nonpalpable testis: the Children’s Hospital of Philadelphia experience. J Urol 159: 1340-1343
Sweeney DD et al. (2007) Minimally invasive surgery for urologic disease in children. Nat Clin Pract Urol 4: 26-38
Swerdlow AJ et al. (1997) Risk of testicular cancer in cohort of boys with cryptorchidism. BMJ 314: 1507-1511
Hadziselimovic F and Herzog B (1997) Treatment with a luteinizing hormone-releasing hormone analogue after successful orchiopexy markedly improves the chance of fertility later in life. J Urol 158: 1193-1195
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Fleet ME et al. (1999) Emerging trends in the management of the impalpable testis. Br J Surg 86: 1280-1282
Elder JS (1992) Two-stage Fowler-Stephens orchiopexy in the management of intra-abdominal testes. J Urol 148: 1239-1242
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Fowler R and Stephens FD (1959) The role of testicular vascular anatomy in the salvage of the high undescended testis. Aust N Z J Surg 29: 92-96
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Poppas DP and Lemack GE (1996) Laparoscopic orchiopexy: clinical experience and description of technique. J Urol 155: 708-711
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Cisek LJ et al. (1998) Current findings in diagnostic laparoscopic evaluation of the nonpalpable testis. J Urol 160: 1145-1149
Yeung CK et al. (1999) A new management algorithm for impalpable undescended testis with gadolinium enhanced magnetic resonance angiography. J Urol 162: 998-1002
El-Anany F et al. (2007) Laparoscopy for impalpable testis: classification-based management. Surg Endosc 21: 449-454
Esposito C et al. (2000) Laparoscopic orchiopexy without division of the spermatic vessels: can it be considered the procedure of choice in case of intraabdominal testis? Surg Endosc 14: 658-660
Frey P and Bianchi A (1989) Microvascular autotransplantation of intra-abdominal testes. Prog Pediatr Surg 23: 115-125
Caldamone AA and Amaral JF (1994) Laparoscopic stage 2 Fowler-Stephens orchiopexy. J Urol 152: 1253-1256
Dhanani NN et al. (2004) Successful outpatient management of the nonpalpable intra-abdominal testis with staged Fowler-Stephens orchiopexy. J Urol 172: 2399-2401
Rozanski TA et al. (1996) The remnant orchiectomy. J Urol 155: 712-713
Taran I and Elder JS (2006) Results of orchiopexy for the undescended testis. World J Urol 24: 231-239
Tackett LD et al. (2002) The high intra-abdominal testis: technique and long-term success of laparoscopic testicular autotransplantation. J Endourol 16: 359-361
Esposito C et al. (2003) Comparison between five different hormonal treatment protocols for children with cryptorchidism. Scand J Urol 7: 345-348
Schwentner C et al. (2005) Neoadjuvant gonadotropinreleasing hormone therapy before surgery may improve the fertility index in undescended testes: a prospective randomized trial. J Urol 173: 974-977
Sahin C et al. (2002) The effects of one- and two-stage orchiopexy on postoperative serum testosterone levels and testicular volume in adult patients with bilateral nonpalpable testes. J Laparoendosc Adv Surg Tech A 12: 327-331
Bukowski TP et al. (1995) Testicular autotransplantation: a 17-year review of an effective approach to the management of the intra-abdominal testis. J Urol 154: 558-561
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Youngson GG and Jones PF (1991) Management of the impalpable testis: long-term results of the preperitoneal approach. J Pediatr Surg 5: 618-620
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Author(s)

Ciro Esposito, MD

Associate Professor of Pediatric Surgery, Department of Pediatrics, University of Naples "Federico II," Naples, Italy

Disclosures

Disclosure: Ciro Esposito, MD, has disclosed no relevant financial relationships.

Anthony A. Caldamone, MD

Professor of Pediatric Surgery and Urology, Division of Urology, Hasbro Children's Hospital, Brown University School of Medicine, Providence, Rhode Island

Disclosures

Disclosure: Anthony A. Caldamone, MD, has disclosed no relevant financial relationships.

Alessandro Settimi, MD

Professor of Pediatric Surgery; Head, Department of Pediatric Surgery, University of Naples "Federico II," Naples, Italy

Disclosures

Disclosure: Alessandro Settimi, MD, has disclosed no relevant financial relationships.

Alaa El-Ghoneimi, MD, PhD

Professor of Pediatric Surgery, Faculty of Medicine, University of Paris VII, Paris, France; Head, Department of Pediatric Surgery and Urology, University Hospital of Robert Debré, Paris, France

Disclosures

Disclosure: Alaa El-Ghoneimi, MD, PhD, has disclosed no relevant financial relationships.

Editor(s)

Nayanah Siva

Locum Editor, Nature Clinical Practice Urology

Disclosures

Disclosure: Nayanah Siva has disclosed no relevant financial relationships.

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Summary and Introduction

Summary

Cryptorchidism is one of the most common genitourinary disorders in young boys. Although the management of boys with palpable testis is standardized, there are no formal guidelines for the management of boys with nonpalpable testis. In this Review we look at the current trends in the diagnosis and treatment of this disorder, as well as the indications for therapy and surgical procedures. On the basis of current evidence, we find that there is no optimum orchidopexy technique for the treatment of intra-abdominal testis, although it is preferable to adopt techniques that preserve the spermatic vessels. We also briefly examine the follow-up of patients with this disorder and its common complications. As yet, there are no data that assess the potential of laparoscopic orchidopexy being a risk factor for impaired fertility later in life.

Introduction

Undescended testis (UDT) is one of the most common congenital abnormalities of the genitourinary system in young boys.^[1-4] Approximately 1-2% of boys at the age of 1 year have a UDT, the disorder being unilateral in about 90% of cases and bilateral in about 10%, depending on the clinical series.^[5-7] About 20% of UDTs are nonpalpable.^[8] The testis can be located in the abdomen in some boys, but it might have been pushed into the upper inguinal canal: this disorder is termed ‘peeping testis’.^[9-11] In about half of the cases of nonpalpable testis (NPT), a testis is located in the abdominal cavity; the remainder are atrophic, either secondary to an antenatal torsion in utero or agenesis.^[12-14]

Despite 15 years of international research on the topic, there are no guidelines on the management of boys with NPT. The management of boys with this disorder is still controversial, and in this Review we aim to summarize the current evidence that is available on the topic and provide an update on how best to manage NPT.

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Diagnostic Procedures

Summary and Introduction
Diagnostic Procedures
Treatment
Discussion
Conclusions

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Table 1.

Table 2.

Table 3.

Table 4.

Table 5.

References

Faculty and Disclosures

Author(s)

Ciro Esposito, MD

Anthony A. Caldamone, MD

Alessandro Settimi, MD

Alaa El-Ghoneimi, MD, PhD

Editor(s)

Nayanah Siva

Management of Boys With Nonpalpable Undescended Testis

Summary and Introduction

Summary

Introduction

Table of Contents