What are the surgical options for treatment of cryptorchidism with nonpalpable testis?

Updated: Dec 17, 2020
  • Author: Joel M Sumfest, MD; Chief Editor: Edward David Kim, MD, FACS  more...
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Answer

An extended inguinal incision; an abdominal incision; or, more commonly, diagnostic laparoscopy is used to explore for a nonpalpable testis. At the time of exploration, one the following 3 main features is likely to be encountered:

  1. Blind-ending spermatic vessels above the internal inguinal ring (44%)
  2. Intra-abdominal testis (36%)
  3. Cord structures (vessels and vas deferens) that enter the internal ring (20%)

Blind-ending vessels suggest vanishing testis syndrome, likely due to an early prenatal vascular event. A blind-ending vas deferens or absent spermatic vessels warrant further exploration of the retroperitoneum up to the level of the renal hilum in order to document the presence or absence of testicular vasculature.

Whether the spermatic cord or vessels entering the ring warrants inguinal exploration for identification of a testis or a testicular nubbin is a topic of debate. Storm et al (2007) have shown residual tubules in up to 18% of these testicular remnants. [66] In addition, removal of the remnants is possible with laparoscopic dissection, sparing the need for an inguinal incision. If a testicular nubbin is found within the scrotum, some surgeons recommend contralateral scrotal testis fixation because a previously unrecognized torsion may have occurred.

Options for the treatment of an intra-abdominal testis vary depending on the patient's age, testis size, contralateral testis, and the surgeon's skills. The author prefers the laparoscopic approach to the intra-abdominal testis.


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