Laparoscopy for the nonpalpable testis.

In boys with an impalpable testis, the gonad may be intraabdominal, canalicular, atrophic secondary to in utero torsion (vanishing), or absent. Although radiological techniques have been used to localize the testis in such patients, they are not sufficiently accurate to avoid surgical exploration. Laparoscopy provides the most rapid and accurate means of localizing impalpable testes. The technique has been demonstrated to be extremely safe. Between 40% and 75% of these boys have a vanishing testis. In the majority of the remainder of cases, the testis is intraabdominal. In boys with an intraabdominal testis, a standard orchiopexy or a one- or two-stage Fowler-Stephens orchiopexy has been used most commonly. In the two-stage Fowler-Stephens orchiopexy, the initial procedure is accomplished laparoscopically by placing a clip on the testicular vessels; the second stage is performed 6 to 12 months later as an open operation. Alternatively, if the patient is a teenager over 16 years of age or an adult, laparoscopic orchiectomy is preferable. Currently efforts are under way to develop and improve the laparoscopic-assisted orchiopexy.