All patients were routinely followedup at our outpatient clinic. A ��successful�� procedure was defined as a testis palpable in the scrotum selleckchem EPZ-5676 and of similar or increased size. Factors evaluated included patient age at operation, side of the impalpable testis, clinical and laparoscopic findings, operative intervention, and outcomes. 3. Results We identified 91 patients, 9 with bilateral and 82 with unilateral impalpable testes, between January 2006 and December 2010, for a total of 100 testes. There was a trend of increasingly performed cases over that period (Figure 1). Mean patient age at the time of surgical intervention was 19 + (interquartile range [IQR], 12�C36) months. The sides of impalpable testes are shown in (Figure 3). Figure 3 Distribution of impalpable testes according to the side affected.
Thirty-seven patients received no further treatment after laparoscopy due to absent testes. In contrast, we found that 11 intra-abdominal testes were high, above the iliac vessels, and 5 were low. The 11 high intra-abdominal testes were managed using the two-stage Fowler-Stephens procedure. This procedure was successful for 3 testes, after a mean followup period of 3.5 months, but unsuccessful in 4; of the latter, 3 underwent orchidectomy for atrophic testes. The remaining 3 were lost to followup. Seven ��low�� intra-abdominal testes were managed using the one-stage Fowler-Stephens procedure, which was successful in 1 and unsuccessful in 1; the remaining 5 were lost to followup.
In 42 testes, the vas and vessels entered the internal inguinal ring; open-standard inguinal orchiopexy was successful in 20 patients and unsuccessful in 10; the latter underwent a second orchiopexy. The remaining 12 were lost to followup Table 1. Table 1 Outcomes relative to intraoperative laparoscopic categorization of impalpable testes. None of these patients experienced any immediate or postoperative complications from laparoscopy. No port site hernia was detected at followup. 4. Discussion Testicular descent, although not yet fully understood, takes place during two different gestational stages, occurring during intrauterine weeks 8 to 15 and 25 to 35. Failure of the first phase of descent is rarer than of the second phase and results in an intra-abdominal undescended testis . However, cryptorchidism is one of the most common genitourinary disorders in young boys. Although the management of boys Anacetrapib with palpable testes has been standardized, there are no formal guidelines for the management of boys with nonpalpable testes . Laparoscopy is currently the most reliable diagnostic modality in the management of impalpable testes. It clearly shows the anatomy and provides visual information upon which a definitive decision can be based .