A boy with undescended Testis (Cryptorchidism)

A 1.5 years old boy was brought with suspicion of absent testis in both sides of scrotum.
A clinical examination revealed left testis to be retractile (which goes up but can be brought down- a normal phenomenon in young age group) and right testis to be an undescended testis (cryptorchidism). This testis could not be felt on clinical examination. The testis which can’t be felt by the doctor may be either undescended intra-abdominal testis (inside abdomen) or it may be absent (10%). Ultrasound and MRI/ CT scan are not reliable for making this diagnosis. The only technique which is 100% sure is laparoscopic or key hole surgery to diagnose and treat such testis.

Parents were explained about need for surgery to bring testis down and the child was taken up for Laparoscopy for diagnosis and treatment of undescended testis. Laparoscopy showed the testis to be present inside the abdomen. This was mobilized and brought down to normal position in the scrotum with laparoscopic surgery.

Showing right scrotum empty

Laparoscopic orchipexy finished-
the telescope inserted via belly button

Laparoscopic view showing right
testis inside the belly

The child did well without any complications of laparoscopic surgery for undescended testis and was discharged the next day. After one week of follow-up, the operation site had healed well and testis was felt well in the scrotum.

Laparoscopy in cases with undescended testis

Laparoscopy or Key Hole Surgery is a recent advance in medicine and has become immensely popular in last two decades. Pediatric Laparoscopy or laparoscopic surgery in children is an upcoming specialty and it has been possible due to availability of miniaturized equipment, small telescopes and above all well trained doctors. The concept of laparoscopy in children is very appealing and is being applied to more and more surgical problems in kids.

For laparoscopy, initially a small hole is made in the belly button or navel to put a telescope and also to infuse a harmless gas (generally carbon dioxide) into the belly. This inflates the belly and gives working space to the surgeon. Then through small holes, instruments are put to perform the procedure. These instruments for kids are really small—the tip size is just 3 mm. A camera is attached to the telescope and is used to watch the procedure on a monitor in a magnified and more precise way. At the end of the surgery, the instruments are removed from the belly and one or two stitches are put within the skin to finish the procedure. These stitches need not be removed. It is amazing how extensive procedures can be performed with 3-4 key hole punctures.

Role of laparoscopy in undescended testis

• Laparoscopy is especially indicated if the testis cannot be felt on clinical examination by a skilled physician signifying that testis is either present inside the belly or may be absent. Rarely a small testis in inguinal canal may not be felt clinically.
• It has been seen in various studies that Ultrasound, CT scan and MRI scan may not be 100% reliable in diagnosing an absent testis or testis within the belly at young age of a child.
• Laparoscopy is the gold standard and best treatment for establishing whether a non-palpable testis is present or absent and also assessing the location to study the feasibility of bringing it down in one stage surgery.
• If the testis is present inside belly a simultaneous Laparoscopic Orchiopexy can be done to bring the testis to normal position.
• Rarely a testis may be located very high up in the belly- in such cases a two staged approach may be required to bring down the testis with a success rate of 90%.
• Best age for Orchiopexy surgery- ideally testis should be brought down by orchiopexy surgery between 6months to 1 year of age as testis damage starts at one year of age.

Laparoscopic surgery for undescended testis in children at young age is best done by expert/ top Pediatric Urologists or Pediatric Surgeons. Pediatric Urologist surgeons understand the anatomy of such birth defects very well and also know how to handle small children the best.

Dr A.K.Singal, one of the best & top expert Pediatric uro-surgeons in Navi Mumbai, India is renowned for laparoscopic kidney and testis surgeries even in 6 months old children. He has done large number of such surgeries in his 20 years of experience in India and USA. Children from all over India come to his hospital for best treatment for undescended testis.