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Naser Amirjannati Corresponding Author
- Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR, Tehran, Iran
Mohammad Mehdi Akhondi
- Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR, Tehran, Iran
Hooman Sadri-Ardekani
- Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR, Tehran, Iran
Haleh Soltanghoraee
- Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR, Tehran, Iran
Mahmood Jeddi-Tehrani
- Monoclonal Antibody Research Center, Avicenna Research Institute (ACECR), Tehran, Iran
Mohammad Hossein Modarresi
1- Nanobiotechnology Research Center, Avicenna Research Institute (ACECR), Tehran, Iran
2- Faculty of Medical Tehran University of Medical Sciences, Tehran, Iran

Received: 1/1/2007 Accepted: 1/1/2007 - Publisher : Avicenna Research Institute

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Abstract

Introduction: Infertility and azoospermia are among the clinical presentations of males with im-palpable testis. The management of non-palpable testis especially in adult patients remains contro-versial. Routine imaging methods like sonography, CTS and MRI are not sensitive enough to detect impalpable testes and have high false negative results. Therefore, it is necessary to perform laparoscopic examination in such patients. Although a few studies have reported benefits of lapa-roscopic examinations in the management of such cases, but it is still subject to many contro-versies showing the need for more investigations in this area. The aim of this study is to evaluate the role of laparoscopy in the diagnosis and treatment (mostly orchiectomy) of impalpable testis in azoospermic men. Materials & Methods: This is a case series study in which the files and laparoscopy movies of patients who had attended Avesina Infertility Clinic form February 2006 to October 2005 and had indication for laparoscopy were retrospectively analyzed. During the study twenty testicular units from 12 married patients with primary infertility and azoospermia were studied. After preliminary evaluations, informed consent for probable orchiectomy was taken from the patients. After preo-perative preparations, diagnostic/surgical laparoscopies were performed. In cases of blind ending vessels or vanishing testes, the procedure was terminated. Orchiopexy or orchiectomy was per-formed based on testis size, distance from internal ring and patient’s age. Results: Twenty testicular units from 12 patients with unilateral or bilateral cryptorchidism were studied. The mean age of patients at the time of attendance and laparoscopy was 37 years (33-43). Eight patients presented bilateral non-palpable testes and four patients with palpable one-sided atrophic testis, two patients had natural descents and two had undergone postpubertal orchiopexy. From the 20 impalpable testes undergoing the procedure, 5 (25%) were absent, 3 vanishing testes and 2 previously done orchiectomies. 15 out of the 20 testes (60%) were located in intra-abdo-minal cavity and were managed successfully by the means of laparoscopic orchiopexy or orchiec-tomy. No laparoscopy related complications occurred. All testicular biopsies from orchiopexy or orchiectomy were sent to a pathology laboratory. Three of the 15 biopsies were reported as atro-phic testis, three as immature testis and 8 of them had germ cell aplasia. Conclusion: The data suggest that laparoscopy can be considered as a safe and effective method for the management of non-palpable testis in adults. The patients may experience less pain and benefit from better cosmetics, early discharge and rapid recovery.


Keywords: Impalpable testis, Azoospermia, Orchiopexy, Laparoscopic orchiectomy, Andrology surgery


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References

  1. Rezvani I. Cryptorchidism: A Pediatricians View. Ped Clin N Am. 1987;34:735.   [PubMed]
  2. Hutson JM, Terada M, Zhou B, Williams MP. Normal testicular descent and the aetiology of cryptorchidism. Adv Anat Embryol Cell Biol. 1996;132:1-56.   [PubMed]
  3. Berkowitz GS, Lapinski RH, Dolgin E. Prevalence and natural history of cryptorchidism. Pediatrics. 1993;92: 44-7.   [PubMed]
  4. Scorer CG. The descent of the testis. Arch Dis Child. 1964;39:605-9.   [PubMed]
  5. Hutson JM, Hasthorpe S, Heyns CF. Anatomical and functional aspects of testicular descent and cryptor-chidism. Endocrinol Rev. 1997;18:259-280.   [PubMed]
  6. Elder JS. The undescended testis: hormonal and surgi-cal management. Surg Clin North Am. 1988;68:983-1005.   [PubMed]
  7. Fallon B, Kennedy TJ. Long term follow-up of fertility in cryptorchid patients. Urology. 1985;25:502-504.   [PubMed]
  8. Rozanski TA, Bloom DA. The undescended testis: Theory and management. Urol Clin North Am. 1995; 22(1):107-18.   [PubMed]
  9. Foresta C, Ferlin A, Garolla A, Milani C, Oliva G, Rossato M. Functional and cytologic features of the contralateral testis incr yptorchidism. Fertil Steril. 1996;66:624-629.   [PubMed]
  10. Riejo R, Lee T, Salo P, Alaqappan R, Brown LG, Rosenberg M, Rosen S, Jaffe T, Straus D, Hovatta O, et al. Diverse spermatogenic defects in humans caused by Y chromosome deletions encompassing a novel RNA-binding protein gene. Nat Genet. 1995;10(4): 383-93.   [PubMed]
  11. Alpert PF, Klein RS. Spermatogenesis in the unilate-ral cryptorchid tesatis after orchiopexy. J Urol. 1983; 129:301-302.   [PubMed]
  12. David AD, Carlos F, Sanjama K, RajwantM, Seetha-lakshmi L. The effects of an LHRH agonist on testicular function in the cryptorchid rat. J Urol. 1992; 147:264-269.   [PubMed]
  13. Seppo T, Outi H, Sakari W. Early treatment of cryp-torchidism, semen quality and testicular endocrinology. J Urol. 1996;156:82-84.   [PubMed]
  14. Lee PA, O'Leary LA, Songer NJ, Coughlin MT, Bellinger MF, Laporte RE. Paternity after unilateral cryptorchidism: A Controlled Study. Pediatrics. 1996; 98:676.   [PubMed]
  15. Lee PA, O'Leary LA, Songer NJ, Coughlin MT, Bellinger NF, Laporte RE. Paternity after Bilateral cryptorchidism: A Controlled Study. Arch Pediatr Adolesc Med. 1997;151(3):260-3.   [PubMed]
  16. Farrer JH, Walker AH, Rajfer J. Management of postpubertal cryptorchid testis: A statistical review. J Urol. 1985;134:1071-6.   [PubMed]
  17. Jacob R. congenital anomalies of the testis and scrotum. In the Compbell’s urology. Patrick C w, Alan BRE. Duracott Vaughan. (Editors). 7th Edition, Phila-delphia, WB saunders Company. 1998;pp:22.
  18. Rangarajan M, Jayakar SM. Laparoscopic orchiec-tomy for the adult impalpable testis: experiences in a rural teaching hospital. Surg Endosc. 2007;21(1):66-9.   [PubMed]
  19. Jacob R. congenital anomalies of the testis and scro-tum. In the Compbell’s urology. Patrick C. Walsh, Alan B, Retic E. Duracott Vauqhan, Alan JW (Editors). 7th Edition. Philadelphia,WB saunders Company. 1998; pp:2172-92.
  20. Anthony AC, Laparoscopy and the management of the nonpalpable testis. In the Laparoscopic surgery. Thomas RG, Mark AT, John LL (Editors). 1st Indian Edition, New dehli, Jaypee Brothers. 1994;pp:161-70.
  21. Abratt RP, Reddi VB, Sarembock LA. Testicular cancer and cryptorchidism. Br J Urol. 1992;70:656-9.   [PubMed]
  22. Kulkarni JN, Desai SM, Phadke GK, Tongaonkar HB. Improved management of abdominal undescended testicular tumors with bulky confluent retroperitoneal nodal metastases. J Urol. 1996;156(4):1341-4.   [PubMed]
  23. Landman J, Evers A, Yan Y, Kibel AS. Management of the postpubertal patient with cryptorchildism: an update analysis. J Urol. 2002; 167:1329-1333.   [PubMed]
  24. Holcomb GW, Brock JW, Neblett WW, Pietsch JB, Morgan WM. Laparoscopy for the nonpalpable testis. Ann Surg. 1994;60:143-147.   [PubMed]
  25. Moore RG, Peters CA, Bauer SB, Mandell J, Retik AB. Laparoscopic evaluation of the non-palpable Testis: a prospective assement of accuracy. J Urol. 1994;151:728-731.   [PubMed]
  26. Thomas RG, David AB, Arnold C. Surgery of the scrotum and testis in children. In the Campbell’s urology. Patrick CW, Alan BR, Duracott E, Alan JW (Editors). 7th Edition. Philadelphia, WB saunders company. 1998;pp:2193-209.
  27. Rogers E, Teahan S, Gallagher H, Butler MR, Grainger R, MCDermott TE, Thornhill JA. The role of orchiectomy in the management of postpubertal cryp-torchidism. J Urol. 1998;159:851-854.   [PubMed]
  28. Maniyur R, Anil M, Anant K, Himanshu C, Avinash S, Mahendra B, et al. Adult cryptorchidism: Unrevea-ling the cryptic facts. Indian J Surg. 2004;66.
  29. Bittencourt DG, Miranda ML, Moreira AP, Miyabara S, Bustorff-silva JM. The role of videolaparoscopy in the diagnosis and therapeutic approach of nonpalpable testis. Int Braz J Urol. 2003;29:345-52.   [PubMed]

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