Sharifiaghdas Farzaneh, Beigi Faramarz M A
Urology Nephrology Research Center, Shahid Labbafinejad Hospital, Shaheed Beheshti Medical University, Tehran, Iran.
Scand J Urol Nephrol. 2008;42(2):154-7. doi: 10.1080/00365590701514654.
There is great controversy regarding the best approach to impalpable testis. In this retrospective study we evaluated the accuracy of intraperitoneal laparoscopy, inguinal canal exploration and ultrasound in the diagnosis of impalpable testis.
Over a 2-year period (2004-06), 76 patients with a diagnosis of uni- or bilateral clinically impalpable testis were referred to our center. A preoperative ultrasound evaluation was done and all patients underwent intraperitoneal laparoscopy. An inguinal canal incision and exploration was done in all cases except for patients with high intra-abdominal testes (> 2 cm above the internal ring), for whom laparoscopic dissection, mobilization and orchidopexy were necessary.
The mean age of the patients was 15.36 years (range 1-39 years). The undescended testis (UDT) was right-sided in 25% of patients, left-sided in 41% and bilateral in 34%. Intraperitoneal laparoscopy, inguinal canal exploration and ultrasound detected 70.6%, 78.4% and 15.6% of testes, respectively.
Laparoscopy changed the management protocol of impalpable UDT in only 21% of cases. Inguinal canal exploration alone was sufficient in the majority of our cases. We recommend laparoscopy for those patients with impalpable UDT in whom an initial inguinal canal exploration proves negative.
对于不可触及睾丸的最佳处理方法存在很大争议。在这项回顾性研究中，我们评估了腹腔镜检查、腹股沟管探查及超声检查在诊断不可触及睾丸方面的准确性。
在2年期间（2004 - 2006年），76例诊断为单侧或双侧临床不可触及睾丸的患者被转诊至我们中心。术前进行了超声评估，所有患者均接受了腹腔镜检查。除腹内高位睾丸（内环上方>2 cm）患者需行腹腔镜下解剖、游离及睾丸固定术外，所有病例均进行了腹股沟管切开及探查。
患者的平均年龄为15.36岁（范围1 - 39岁）。隐睾（UDT）位于右侧的患者占25%，左侧的占41%，双侧的占34%。腹腔镜检查、腹股沟管探查及超声检查分别检测出70.6%、78.4%及15.6%的睾丸。
腹腔镜检查仅在21%的病例中改变了不可触及UDT的治疗方案。在我们的大多数病例中，单独进行腹股沟管探查就足够了。对于那些最初腹股沟管探查结果为阴性的不可触及UDT患者，我们建议进行腹腔镜检查。
