Does the Contralateral Testicular Volume Decide the Need for Diagnostic Laparoscopy in Cases of Unilateral Impalpable Undescended Testis?
Phase: NA
Conditions: Pediatric ALL
Sponsor: Egyptian Biomedical Research Network

Cover letter 
Title: Value of contralateral testicular hypertrophy in predicting the status of 
the intra-abdominal testis? 
Running title: contralateral testicular hypertrophy in intra-abdominal testis 
Category of the manuscript: Research article 
Serial N: 0305079 
Document Date: March 19, 2021 
I have the honor to submit this original research article entitled “Does 
the contralateral testicular volume decide the need for diagnostic 
laparoscopy in cases of unilateral impalpable undescended testis?” for 
clinical registration aiming at your helpful review and hopefully your 
acceptance for registration. 
This manuscript has not been published and is not under consideration 
for publication elsewhere.  The investigators have no conflicts of interest to 
disclose and this manuscript has not received any financial funds.  All of the 
co-authors, as well as the Alexandria University Scientific Committee, 
approved its publication and informed consent was signed by the parents 
explaining the study. 
Thank you for your consideration! Waiting for your respectable reply. 
 
 

Abstract 
Background: This study aimed at the evaluation of the value of the 
estimated volume of a normal testis to predict the status of its contralateral 
impalpable side and hence decide the importance of laparoscopic exploration. 
Methods: Participants with unilateral impalpable maldescended testis – as 
confirmed by clinical and sonographic examination- were enrolled in this 
prospective interventional study between November 2018 and August 2022 at 
Elshatby University Hospital, Faculty of Medicine, Alexandria University. 
The volume and three-dimensional diameter of the normal contralateral testis 
were measured by the pre-operative US using the formula: Volume = L x W 
x H x π/6, where L is the length, W is the width, H is the height, and was 
correlated with the intra-operative laparoscopic findings. 
Keywords: Impalpable testis; volume; ultrasound  
Background 
Maldescended testis or cryptorchidism is considered the most common 
congenital genito-urinary abnormality faced in male neonates with an 
incidence of 3% in full-term babies and increasing up to 30% in preterm 
males. However, this incidence declines to about 1% by the age of 3 months 
as it descends to its normal position in about 80% of cases. 1,2 

Only 20 % of maldescended testis is impalpable being either vanishing 
due to an intra-uterine accident, agenetic, intra-abdominal, or inguinal with 
different degrees of dysplasia and atrophy. 3 
The gold standard method for a definitive diagnosis and management 
of impalpable maldescended testis is laparoscopy and according to its 
findings; the procedure is planned whether nothing in case of vanishing or 
agenetic testis, inguinal exploration in case of passing through the DIR or 
traction, Fowler-Stevens (FS) or one stage laparoscopic assisted orchiopexy 
in case of the intra-abdominal testis. 3,4 
The size of the contralateral testis has been used to predict the condition 
of its contralateral impalpable one while being explored by laparoscopy by 
many researchers. 5 Ultrasound (US) is considered by many surgeons as being 
an accurate, reproducible, and objective in situ tool for the assessment of 
testicular dimensions and volume. 6 
This study aimed at the assessment of the ability of the three 
dimensional size as well as the volume of a normal testis as measured by 
ultrasonography in predicting the status of its contralateral impalpable 
counterpart and hence deciding the need for proceeding to laparoscopic 
exploration of this impalpable maldescended testis. 

Methods 
This prospective interventional study included children with unilateral 
impalpable maldescended testis presented to Elshatby University Hospital, 
Faculty of Medicine, Alexandria University from November 2018 to August 
2022. Participants with bilateral impalpable maldescended testis and those 
with post-operative ascended testis were excluded from the study. 
           After approval of the ethics committee of Alexandria Faculty of 
Medicine, informed consent was obtained from all parents and legal guardians 
of the children included in the study. Careful collection of the demographic 
data of all of the studied participants was followed by careful clinical 
examination. US abdomen, pelvis, and the inguino-scrotal region performed 
by the same sonographer were done for: 
1. Assessment of the three-dimension diameters as well as the volume 
of the normal-sided testis. It is measured by the formula: Volume= 
L x W x H x π/6, where L is the length, W is the width, and H is the 
height. 
2. Searching for the impalpable testis at all its suspected sites; intra-
abdominal, pelvic, or in inguinoscrotal region 

All of the participants were subjected to laparoscopic exploration under 
general anesthesia with endotracheal intubation and the following data 
regarding the findings of the affected impalpable side was collected: 
A. Testicular size in millimeters 
B. Absent testis: Blind ending vas and vessels 
C. Present intra-abdominal testis 
D. Testis passing through the deep inguinal ring (DIR) 
E. Patency of the DIR on the affected side (closed or open) 
The procedure which was done according to the laparoscopic findings 
was also documented  
A. Absent testis: Nothing 
B. Present intra-abdominal testis: Traction 1, Fowler Stephens or 
laparoscopic assisted orchiopexy 
C. Testis passing through the deep inguinal ring (DIR): Inguinal 
exploration and orchiopexy or excision in case of atrophied testis 
Statistical Analysis 
Data were fed to the computer and analyzed using IBM SPSS software 
package version 20.0. (Armonk, NY: IBM Corp). The Shapiro-Wilk was 
used to verify the normality of the distribution of variables, Comparisons 

between groups for non-parametric variables were assessed using the Mann 
Whitney test or Kruskal Wallis test. The significance of the obtained results 
was judged at the 5% level.