腹腔镜诊断 - 1岁的男孩，未触及睾丸（睾丸发育不全）

                               
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1 year old boy with non palpable left testis since birth, right side normal testis on the scrotum. Ultrasound found no testis on left side.
Laparoscopy was performed to diagnose and possible threatment.
During the surgery, only a vas deferens stump was visualized on the left side, without testicular vessels. Ressection of the vas deferens stump (Orchidolysis) was performed to avoid possible malignization of the stump.

Surgical Crew: IgorTFerreira / Dr. Aratanha

November 2015


Brief Literature Review About Nonpalpable Testis

- If the testis is non-palpable: examination under anaesthetic may reveal the previously non-palpable testis. The role of laparoscopy in the case of non-palpable cryptorchidism is both diagnostic and therapeutic. Laparoscopic orchiopexy for non-palpable testes is usually the preferred surgical approach among paediatric urologists. Removal, orchidolysis or orchidopexy can then be performed laparoscopically.

- Complications
Increased risk of testicular torsion. This may be associated with the development of a testicular tumour. Torsion of an intra-abdominal testis may present as an acute abdomen.

- Effect on fertility
Boys with one undescended testis have a lower fertility rate but the same paternity rate as boys with bilateral descended testes.
Boys with bilateral undescended testes have lower fertility and paternity rates.

- Risk of testicular malignancy
There is a three-fold increase in the incidence of testicular cancer in males with undescended testes.
There is a history of cryptorchidism in 5-10% of testicular cancers.
Prepubertal orchidopexy for cryptorchidism may be associated with a lower risk of testicular cancer.
Orchidopexy facilitates testicular self-examination.

- Cosmetic appearance
Surgical transfer of the testis into the scrotum produces a better cosmetic appearance.
Prostheses may be used if the testis is removed. Prostheses should be implanted during adolescence.