Laparoscopy for nonpalpable testis: Is inguinal exploration always necessary when the cord structures enter the inguinal ring?

On laparoscopic examination, about half the cases of impalpable testis present cord structures entering the inguinal ring. The aim of this study was to verify the validity of laparoscopy in selecting patients who need inguinal exploration. Since 1992, 40 laparoscopies (41 impalpable testis) have been performed in the authors' institution. The patients' ages ranged from 1 to 8 years (average, 4). After the introduction of the first trocar by an open approach, the internal inguinal ring on the side of the normally descended testis was studied, and the iliac areas and the pelvis were inspected with particular attention to the internal inguinal ring patency. In 6 patients (15%), blind ending cord structures were found above the inguinal ring. An intrabdominal testis was found in 13 patients (32.5%). In 21 patients, cord structures entering the inguinal ring were observed; 18 had hypoplasic spermatic vessels and a closed processus vaginalis. An inguinal exploration was performed, and specimens for histologic examination were collected when cord structures entering the inguinal ring were observed. Scars and/or calcifications were found in 70% and 50% of the cases, respectively; viable germ cells were identified in two remnants; no malignancy was recorded. No complications occurred, and all the patients were discharged 1-2 days postoperatively. Inguinal exploration can be avoided when hypotrophic vessels are found entering a closed internal inguinal ring, since hypotrophic vessels are inequivocable signs of intracanalicular vanishing testis. Inguinal exploration is indicated in syndromic patients and when normally developed vessels and/or open inguinal ring are found on laparoscopy.