Role of Laparoscopy in Undescended Testis in children

Abstract

Cryptorchidism or undescended testis is one of the most common anomalies in pediatric surgery. It is estimated to affect 1 to 4 percent of full term and up to 30 percent of premature male neonates. Spontaneous descent is possible until 6 months of age. Although, cryptorchidism is usually considered to be a congenital condition, an increasing number of older boys with a previous normal exam are being diagnosed with a UDT. Typically, these boys have a scrotal testis that “ascends” to a low inguinal position, therefore they require an orchiopexy. Some boys have secondary cryptorchidism after repair of an inguinal hernia. The high frequency of cryptorchidism is a concern, although the epidemiological explanation for this is obscure. Likewise, the causes of UDT remain largely unknown, but indirect evidence suggests that the disease is heterogeneous and most likely the result of multiple genetic, hormonal and environmental risk factors. There are a number of different abnormalities and syndromes in which the incidence of cryptorchidism is significantly higher than in the general population. However, when understanding the pathogenic relationship, each abnormality and syndrome may give some information that can explain the different aspects of testicular maldescent. The classification of UDT is becoming much clearer with the recognition that many ‘retractile’ testes develop into ascending, acquired UDT. Retractile testes should now be treated with caution, as they are in a grey zone between normality and abnormality. The undescended testis may be morphologically normal or abnormal at the time of birth, the dysplasia of testicular tissue leads to increased risk of infertility and malignant degeneration. There is a trend towards imaging by ultrasonography of patients with both unilateral and bilateral impalpable testes. Unfortunately, the testis for which accurate localization would be useful, especially the intra-abdominal testis, the technique is unreliable. Therefore, preoperative imaging like USG, CT and MRI do not change the surgical management of non-palpable testes because a reliable imaging modality is not yet available that can be used in lieu of the gold standard of laparoscopy to correctly identify the presence and location of a non-palpable undescended testis. Additionally, by ordering preoperative imaging in these cases, it may delay evaluation and treatment by a surgical specialist, adding to this the costs of health care