Management of Non Palpable Undescended Testis.

Vijay Anand, C (2011) Management of Non Palpable Undescended Testis. Masters thesis, Madurai Medical College, Madurai.


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INTRODUCTION : Undescended testis is a common Paediatric Surgical condition which is conventionally managed surgically by Orchidopexy. It can either be palpable or non-palpable clinically. Inguinal exploration is the standard widely accepted approach for all children with palpable undescended testis. But the optimal surgical approach for the non-palpable testis is still debated. Laparoscopy and open surgical exploration are the two options, each having its own benefits and draw backs. Laparoscopy is said to have several advantages, mainly to locate the testis accurately, help in mobilization and remove any atrophic elements, if present. But the problem in subjecting all these children to initial laparoscopy is that in many instances the non-palpable testis may be located at or distal to the deep ring, which just needs a inguinal exploration. Recently several studies have come up stating that non-palpable testis can be adequately managed by standard inguinal approach, and laparoscopy may only increase the time and cost in majority of the children without actually influencing the results. AIM : This study is aimed at analyzing : The role of standard primary inguinal exploration in the management of Non- Palpable Undescended testis in children. The incidence of scrotal or inguinal testis/ testicular structures in cases with non- palpable undescended testis. The incidence of normal viable testis, hypoplastic testis, non-viable testis or vanishing testis in children with non-palpable Undescended Testis. The importance of palpable cord structures in assessing the position of the testis and its appropriate management by primary inguinal exploration. Forming a new algorithm for Non palpable undescended testis MATERIALS AND METHODS : All the children with non-palpable undescended testis who were operated in our hospital (n=30), between August 2008 and August 2011, were taken for this study. Their history and complaints were recorded. Thorough clinical examination performed and attempts made to locate a testis. Attempts were made to locate and palpate the cord structures, if at all present. An ultra-sonogram was done for almost all these cases and the findings documented. All these cases underwent Diagnostic Laparoscopy followed by Laparoscopic or open Orchidopexy, depending upon the location of the testis. In a very few cases where testis was a nubbin testis, an Orchidectomy was done. The position of the testis, the nature of the testis and the procedure performed were recorded. These data were analyzed and compared with various reported studies and the choices of surgical procedures for non-palpable Undescended testis. CONCLUSION : Most of the cases coming to Government institutions are late presentations – 9o% present later than two years. Information and drives to improve public awareness should be done for early reporting and surgical correction of this condition. Referring Doctors should also be imparted knowledge on the timing of Surgery, as many of them do not advice the patients correctly regarding the time of Surgery even when the patient reports to them for this specific complaint. In around 84% of Non-palpable Undescended testis, the testis or testicular structures are found to be present at or beyond the level of the deep ring which could be managed by inguinal exploration. Hence primary inguinal exploration would be sufficient in all these cases avoiding unnecessary laparoscopic abdominal exploration. And Laparoscopic exploration is found to be influential in deciding the procedure in only less than 15% of the cases. Hence we would advocate Inguinal exploration as a primary procedure of choice and relegate laparoscopy to the negative explorations, thus obviating a lot of unnecessary expenditures, risks and cost to the patients. Hence, as evidenced from our study, if the cord is clinically palpable, testis will invariably be present in the scrotum or the inguinal region, and this can be dealt in easily with inguinal approach rather than subjecting all the children to primary laparoscopic exploration. This may help in mitigating unnecessary laparoscopic exploration and the study has showed it to be fool proof. (In cases with palpable cord clinically, testis was found to be in the inguinal or scrotal region in 100% of the cases.) So we would like to reinforce this ‘cord sign’ (term coined by our Professor), and it should be brought into the clinical examination of UDT, which will help in avoiding unnecessary Laparoscopic abdominal exploration and is proved to be fool-proof. If the cord is palpable even though the testis is not palpable, the testis is in the Inguinal region, as our studies confirm.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Non Palpable Undescended Testis ; Management.
Subjects: MEDICAL > Paediatric Surgery
Depositing User: Kambaraman B
Date Deposited: 28 Jul 2017 03:38
Last Modified: 28 Jul 2017 03:58

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