ROLE OF LAPAROSCOPY IN NON PALPABLE UNDESCENDED TESTIS.

Purpose: To Evaluate Laparoscopic Diagnostic Findings in Nonpalpable Undescended Testes and Analyze the Success Rate & Outcome of Laparoscopic Orchidopexy. Methods: This was a prospective study carried out in the Department of Paediatric Surgery Sri Ramachandra Medical College and Research Institute from June 2006 to December 2008.We used diagnostic and operative laparoscopy in the management of 52 patients with 61 undescended testes. Boys with the palpable testis at any point were excluded from the study. Results: Out of these patients 26(boys), 28 testes (45%) were palpable and 26(boys), 33 testes (54%) were Nonpalpable. Age range from 9 months to 17 years (median age 5.3 years) .Out of 33 Nonpalpable testes 7(21%) were on the right side, 12(36%) on the left and 14(42%) bilateral. Diagnostic Laparoscopy Findings (n= 33) 1. Deep ring was open in 25(75.7%) and closed in 8(24.2%). 2. Vas and Vessels were seen entering the deep ring in 3 patients and thus inguinal exploration carried out 3. Morphology of testes were Hypoplastic 11(33.3%), Atrophic 3(9.09%), Normal 18(54.5%), 4. Blind ending vas and vessels 1(3.03%). Operative Procedures: (n=33) 1. Diagnostic Laparoscopy only :1(blind ending vas and vessels) 2. Inguinal Exploration 3 cases: 2 Orchidopexy, 1 Orchidectomy. 3. Laparoscopic Orchidopexy : 24 4. Laparoscopic Orchidectomy : 5 5. Overall success for Laparoscopic Orchidopexy 24 (92.3%) and Atrophy in 2 (7.6%) testes. 6. Major associated procedure was Laparoscopic division of Persistant Mullerian Structure. 7. Conclusion : 1. Considering all our findings, we believe that laparoscopy conformed its value in the diagnostic and therapeutic approach of Nonpalpable testes, which facilitated the choice of an optimal surgical strategy 2. Diagnostic Laparoscopy in our series provided 100% dependable direction for the definitive management of Nonpalpable testes.