SS  Vol.3 No.9 , September 2012
Bilateral Impalpable Testes: A Special Entity of Cryptorchidism
Abstract
Background: Cryptorchidism is one of the most common genitourinary disorders in young boys. About 1% - 2% of boys at age of 1 year have an undescended testis (UDT); this disorder is unilateral in about 90% of individuals and bilateral in about 10%. However, bilateral impalpable testes represent a special category that should be differentiated from anorchidism as well as male pseudohermaphroditism. We investigated whether bilateral impalpable testes with its inherent hormonal and genetic factors has different outcomes in terms of success of orchiopexies compared to unilateral impalpable testes. Methods: We retrospectively analyzed the demographic and clinical findings, as well as immediate and 6 month outcomes, in patients diagnosed with bilateral impalpable undescended testes between 2006 and 2010. Findings were reported after a minimum of 6 months from the last surgical intervention. Results: Nine patients underwent laparoscopy for bilateral impalpable testes, 7 of whom had testes in the region of the internal inguinal ring. The success rate after laparoscopic exploration and open orchiopexy was 60% while the success rate with unilateral impalpable testes was 63.3% in the same study. Conclusion: Although laparoscopy is extremely useful in both the diagnosis and treatment of patients with bilateral impalpable testes, laparoscopy should be preceded by careful cytogenetic and hormonal workup for this particular group of patients. We found that the success rates of laparoscopic management of bilateral and unilateral impalpable testes were similar, as shown by testicular size clinically sassed during serial postoperative outpatient visits.

Cite this paper
T. Abbas, A. Hayati and M. Ali, "Bilateral Impalpable Testes: A Special Entity of Cryptorchidism," Surgical Science, Vol. 3 No. 9, 2012, pp. 457-459. doi: 10.4236/ss.2012.39090.
References

[1]   D. D. Sweeney, et al., “Minimally Invasive Surgery for Urologic Disease in Children,” Nature Clinical Practice Urology, Vol. 4, No. 1, 2007, pp. 26-38. doi:10.1038/ncpuro0677

[2]   A. J. Swerdlow, et al., “Risk of Testicular Cancer in Cohort of Boys with Cryptorchidism,” British Medical Journal, Vol. 314, 1997, pp. 1507-1511. doi:10.1136/bmj.314.7093.1507

[3]   F. Hadziselimovic and B. Herzog, “Treatment with a Luteinizing Hormone-Releasing Hormone Analogue after Successful Orchiopexy Markedly Improves the Chance of Fertility Later in Life,” Journal of Urology, Vol. 158, No. 3, 1997, pp. 1193-1195. doi:10.1097/00005392-199709000-00130

[4]   C. Esposito and V. Garipoli, “The Value of 2-Step Laparoscopic Fowler-Stephens Orchiopexy for Intraabdominal Testes,” Journal of Urology, Vol. 158, No. 5, 1997, pp. 1952-1954. doi:10.1016/S0022-5347(01)64189-2

[5]   F. El-Anany, et al., “Laparoscopy for Impalpable Testis: Classification-Based Management,” Surgical Endoscopy, Vol. 21, No. 3, 2007, pp. 449-454. doi:10.1007/s00464-006-9003-0

[6]   J. M. Hutson and M. C. C. Clarke, “Current Management of the Undescended Testicle,” Seminars in Pediatric Surgery, Vol. 16, No. 1, 2007, 64-70.

[7]   C. Esposito, et al., “Management of Boys with Nonpalpable Undescended Testis,” Nature Clinical Practice Urology, Vol. 5, No. 5, 2008, pp. 252-260.

[8]   J. M. Hutson, “Undescended Testes,” In: M. D. Stringer, K. T. Oldham and P. D. E. Mouriquand, Eds., Pediatric Surgery and Urology: Long-Term Outcomes, 2nd Edition, Cambridge University Press, Cambridge, 2006, pp. 652-663. doi:10.1017/CBO9780511545757.052

[9]   L. A. Baker, et al., “Cryptorchidism,” In: J. Gearhart, R. Rink and P. D. E. Mouriquand, Eds., Pediatric Urology, W.B. Saunders, Philadelphia, 2001, pp. 738-753.

[10]   K. Kubini, et al., “Basal Inhibin B and the Testosterone Response to Human Chorionic Gonadotropin Correlate in Prepubertal Boys,” The Journal of Clinical Endocrinology & Metabolism, Vol. 85, No. 1, 2000, pp. 134-138. doi:10.1210/jc.85.1.134

[11]   R. Rey, “How to Evaluate Gonadal Function in the Cryptorchid Boy. Lessons from New Testicular Markers,” Journal of Pediatric Endocrinology & Metabolism, Vol. 16, 2003, pp. 357-364. doi:10.1515/JPEM.2003.16.3.357

[12]   N. Lahlou, “Marc Roger Inhibin B in Pubertal Development and Pubertal Disorders,” Seminars in Reproductive Medicine, Vol. 22, No. 3, 2004, pp. 165-174.

[13]   P. Christiansen, A. M. Andersson, N. E. Skakkebaek, A. Juul, “Serum Inhibin B, FS, LH and Testosterone Levels before and after Human Chorionic Gonadotropin Stimulation in Prepubertal Boys with Cryptorchidism,” European Journal of Endocrinology, Vol. 147, 2002, pp. 95-101. doi:10.1530/eje.0.1470095

[14]   S. Y. Tennenbaum, et al., “Preoperative Laparoscopic Localization of the Non Palpable Testes, a Critical Analysis of a 10-Year Experience,” Journal of Urology, Vol. 164, 2000, pp. 154-155.

[15]   E. Mohamed, M. D. Hassan and M. D. Abdulrahim Mustafawi, “Laparoscopic Management of Impalpable Testis in Children, New Classification, Lessons Learned, and Rare Anomalies,” Journal of Laparoendoscopic & Advanced Surgical Technique, Vol. 20, No. 3, 2010, pp. 265-269.

 
 
Top