Last updated: September 12, 2019
Topic: FamilyBabies
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The word cryptorchidy comes from the Grecian roots Kryptos hidden and Orchis testicle and means absence of testicle from the scrotum, which would be undescended, retractile, ectopic or absent ( 1 ) .

Incidence varies with patient ‘s age from 30 % in premature newborns to 0.8 % in one-year-old babies. Unilateral in 68 % of instances, 70 % of instances in the right side. ( 2 )

20 % of non-palpable testicles are absent.

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Non-palpable testicles have an increased hazard of malignant transmutation, is extremely associated with sterility and epididymal deformity ( 3 ) . Many diagnostic methods have been described ; the most promising is the usage of laparoscopy ( 4 ) .

We present our experience with laparoscopy in the rating of intangible testicles.

Materials and methods: –

The standards established for laparoscopy were testicular absence detected by physical scrutiny, ultrasound or scrutiny under anaesthesia.

Between the periods of January 2002 and September 2003, a sum of 16 patients ( age scope from 16 to 24 with a average age of 20 twelvemonth ) with 19 intangible testicles underwent laparoscopic rating at the infirmaries of Royal Medical Services.

Data collected included patients ‘ age, affected side, size of testicles, place, operation performed and complications.

Testes non tangible at office visit but tangible at surgery were defined as being tangible testicles, and were excluded from this survey.

Hormonal profile was non done to our patients as it was non indicated.

Under general anaesthesia, with the patient in the Trendelenburg ‘s place, a 5mm subumbilical scratch was deepened into the peritoneum and a 5mm Hasson blunt trocar was inserted. The venters so insufflated with Carbon Dioxide ( force per unit area bound 16 centimeter H2O ) . The venters is inspected to govern out any hurt, and so with peculiar attending to landmarks testicular location, the location of vessel deferens, and the testicular vass and the presence of a patent processus vaginalis are attempted.

Further surgical intercession was so arranged harmonizing to the findings during laparoscopy.

The process is started by review along the psoas trough superiorly and the internal ring until we detect the spermous vass. In instances when the vass or the vessel were non visualized clearly this is an indicant of a congenitally absent testicle.

If the vass are visualized they are followed down every bit far as possible to make the terminal terminal which might hold the atrophic or little testicle. This can be achieved with the aid of a 5-mm forceps and scissors. If the testicle was found to be atrophic, orchiectomy was performed by niping the vass and extraction of the testicles. In younger kids orchidopexy is a executable option.

Consequences: –

Sixteen patients ( with age scope from 16 to 24 old ages ( average age of 20 old ages ) ) underwent laparoscopy to place 19 intangible testicles. Thirteen patients had one-sided intangible testicle while 3 patients had bilateral intangible testicle.

Thirteen testicles were atrophic ( 68 % ) and 6 were absent ( 32 % ) . Out of the 19 intangible testicles, 12 were in the right side ( 63 % ) and 7 on the left side ( 37 % ) .

Abdominal ultrasound and CT scan were performed for all patients to corroborate the clinical diagnosing, abdominal ultrasound revealed positive consequences in 11 testicles ( 58 % ) , nevertheless, abdominal Ct scan showed positive consequences in 16 testicles ( 85 % ) .

Consistency was found between clinical findings and histopathological biopsy as shown in tabular array I.

There were no instances of nephritic agenesia.

Laparoscopic orchiectomy was done in all instances of atrophic testicles.

Histopathological study for all extracted testicles reported as that the subdivisions contain parts of testicular tissue demoing peritubular fibrosis and interstitial fibrosis. Spermatogenesis activities were non seen. There were no any pre-malignant alterations. A concluding diagnosing of atrophic testicles. ( Table 1 )

Table 1 Summary of Results

Pt. No.

Age ( year )

Side

U/S

Connecticut

Finding

Biopsy

Size

1

20

Left

Negative

Positive

Absent

Absent

N.A*

2

22

Bilat.

Positive

Positive

atrophic

wasting

2x2x1

3

16

Right

Negative

Positive

Absent

Absent

N.A*

4

18

Right

Negative

Positive

atrophic

wasting

1×1.5×2

5

24

Right

Positive

Negative

atrophic

wasting

1x1x1.5

6

21

Bilat.

Negative

Positive

atrophic

wasting

2.5x1x1

7

22

Left

Negative

Negative

atrophic

wasting

2x1x1

8

23

Left

Positive

Positive

Absent

Absent

N.A*

9

18

Right

Positive

Negative

atrophic

wasting

1x1x1.5

10

20

Right

Positive

Positive

atrophic

wasting

1x2x1.5

11

19

Right

Negative

Positive

Absent

Absent

N.A*

12

21

Left

Positive

Positive

atrophic

wasting

1x2x1

13

17

Bilat.

Positive

Positive

Absent

Absent

N.A*

14

17

Right

Positive

Positive

atrophic

wasting

1x1x1.5

15

23

Right

Positive

Positive

atrophic

wasting

2x1x1.5

16

23

Right

Negative

Positive

atrophic

wasting

2x1x1.5

N.A* : – Not available

Discussion: –

Laparoscopic surgery has become popular in the surgical diagnosing and intervention of intangible testicles owing to its efficaciousness, minimum invasiveness and lower morbidity rate ( 5, 6, 7 ) . It provides us with information about testicular location, testicular presence or absence and allows definite direction ( 8 ) . Laparoscopy helped a batch in the direction of the intangible testicles where localisation can be done accurately since other modes like ultrasound and CT scan have failed to accomplish this end particularly in intra abdominal testicles.

During surgery proper scrutiny under anaesthesia is so helpful to happen inguinal testicles which were missed on clinical physical scrutiny. Examination under anaesthesia should ever be done as first measure in diagnostic laparoscopy for intangible testicle ( 9 ) .

Laparoscopy is helpful in diagnosing of disappearing testicle and gives us precise information about its location in all instances. ( 8 ) .

If the vessel or vass come ining the ring are clearly atretic this indicates that it is improbable to happen feasible testicle intending a congenitally absent testicle ( 2 ) . However the presence of notably decreased size in comparing of normal size of the mentioned constructions does non except the presence of feasible testicle ( 5 ) . In add-on, the presence of normal looking vessel or vass give opportunity of merely 50 % to happen feasible testicles which can be surgically salvaged ( 10 ) .

Laparoscopy help us to place an intra abdominal vanishing testicles with a lower morbidity rate in comparing with the demand of an extended unfastened abdominal geographic expedition ( 1 ) .

Laparoscopy is safe, minimally invasive process with low morbidity. It enables precise diagnosing and direction of intangible testicle.

In add-on laparoscopic process has better consequences than unfastened processs with the advantage of smaller scratchs, better diagnosing of the presence or absence of the testicles and better localisation of the testicles. It has the advantage of the possibility of laparoscopic orchiectomy or orchidopexy and eventually shorter postoperative recovery.

Restriction of the Survey: –

Hormonal profile was non done.

Decision: –

Laparoscopic diagnosing and direction of intangible testicles is safe, effectual and minimally invasive technique with low morbidity that enables precise diagnosing of intangible testicles ( 4, 5, 6, 7 ) .

Adding to this it has better decorative consequences and advantage in instance of bilateral disease. It needs shorter operative clip, shorter infirmary stay where this process is done on footing of twenty-four hours instance surgery and before return to normal activities ( 5 ) .