Non-Descent Of The Testis: An Overlooked Laparoscopic Finding

Main Category: Urology / Nephrology
Also Included In: Pediatrics / Children's Health
Article Date: 05 Sep 2008 - 3:00 PST

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UroToday.com - A manuscript by Dr. M. A. El Gohary on non-descent of the testes was published in the Journal of Pediatric Urology. The author shared cases of impalpable testes where the testes were located in a subrenal position. Laparoscopies were performed, and looping vas deferentia were noted to be going up the colonic gutter towards the kidney. The testes were found just below the kidneys in seven patients. The author performed laparoscopic Fowler-Stephen procedures in all of these cases. Two testes were lost and the remaining were salvaged.

We have also had experience with these very high testes. We found that mobilization of the vessels can help bring these testes down into the scrotum the majority of the times. We have also had to perform a single-stage Fowler-Stephen procedure when the vessels were only tethering the testis and we could not bring these testes down into the scrotum. Care was taken not to manipulate the vas deferens or disturb its blood supply. We have had three of these cases and have been able to salvage all 3 testes in the acute postoperative period. Nonetheless, after one year of follow-up, we did have one of the testis atrophy. The real lesson here is that if you do find a looping vas deferens and there are no vessels going through the ring, you really have to search for the testes. Sometimes mobilizing the colon, or at least looking up towards the gutter near the lower pole of the kidney, is imperative.

M.A. El Gohary
J Pediatr Urol 2008 (Epub ahead of print)

Reported by UroToday.com Medical Editor Pasquale Casale, MD

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