Role of Laparoscopy in Management of Non-palpable Undescended Testis : Assuit University Experience
Role of Laparoscopy in Management of Non-palpable Undescended Testis : Assuit University Experience
1. To evaluate the role of laparoscopy in diagnosis & treatment of Non- palpable
 undescended testis

 2. To compare between different laparoscopic techniques

 3. To introduce new laparoscopic technique in Assuit university " shehata technique "
Cryptorchidism or undescended testis (UDT) is one of the most common genital anomalies in
 childhood. Its incidence is 3-5 % in full term newborn, and affect more than one third of
 premature newborn. The incidence decrease to 1 % at age of 3months. About 20% of UDT are
 impalpable, and about 50% of these impalpable testes are either vanished or atrophic (1-3).

 Many diagnostic methods have been used for the evaluation and management of the undescended
 testis, including imaging studies and multiple surgical procedures.

 Surgical management of UDT is performed to preserve testicular function (spermatogenesis) and
 to prevent the potential complications of undescended testis(1).

 Regarding the optimal age of orchiopexy many recent findings suggest that early intervention
 (6 -12 months of age) is most beneficial. Other findings suggest that there is high rate of
 spontaneous descent during the first 3 months of life, so observation of undescended testis
 is advocated till 3 months of age, if the testis remains non-palpable at 3 months of age, it
 is unlikely to become palpable by waiting another 3 months. Therefore, diagnostic laparoscopy
 and orchidopexy could be performed from 3 months of age(2).

 For intraabdominal cryptorchidism, laparoscopic surgery has been accepted by most surgeons as
 the preferred technique for diagnosis & treatment (4).

 Laparoscopic findings in non-palpable testis include ; Absent testis either ; Agenesis (
 absence of spermatic vessels and vas deferens ) or vanishing testis ( blind ending of
 spermatic vessels or vas ) , Canalicular testis ; Penetration of vas and spermatic vessels
 into the internal inguinal ring with or without directly seeing the testis , Abdominal testis
 Localized between the inferior renal pole and the ipsilateral internal inguinal ring. Can be
 low (< 2cm) or high (>2cm) from internal inguinal ring , Peeping ; Primarily in
 intra-abdominal position. The testis introduces itself into the inguinal canal due to the
 intra-abdominal pressure augmentation during the laparoscopic procedure.(5)

 Several techniques have been described for treatment of intra-abdominal testis including
 microsurgical auto-transplantation, primary laparoscopic orchiopexy (VILO), one- and
 two-stage laparoscopic Fowler-Stephens procedures, and staged laparoscopic traction
 orchiopexy (Shehata technique
Inclusion Criteria:

 -  any patient admitted to pediatric unit in Assuit University hospital with non palpable
 testis ( NPT )below age of 6 years

 Exclusion Criteria:

 -  patients with NPT above age of 6 years

 -  patients with atrophic or vanishing testis

 -  patients with previous failed laparoscopic orchiopexy