Role of Laparoscopy in Management of Non-palpable Undescended Testis : Assuit University Experience

Study Overview
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Brief Summary
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To evaluate the role of laparoscopy in diagnosis & treatment of Non- palpable undescended testis To compare between different laparoscopic techniques To introduce new laparoscopic technique in Assuit university  shehata technique 

Detailed Description
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Cryptorchidism or undescended testis (UDT) is one of the most common genital anomalies in childhood. Its incidence is 3-5 % in full term newborn, and affect more than one third of premature newborn. The incidence decrease to 1 % at age of 3months. About 20% of UDT are impalpable, and about 50% of these impalpable testes are either vanished or atrophic (1-3). Many diagnostic methods have been used for the evaluation and management of the undescended testis, including imaging studies and multiple surgical procedures. Surgical management of UDT is performed to preserve testicular function (spermatogenesis) and to prevent the potential complications of undescended testis(1). Regarding the optimal age of orchiopexy many recent findings suggest that early intervention (6 -12 months of age) is most beneficial. Other findings suggest that there is high rate of spontaneous descent during the first 3 months of life, so observation of undescended testis is advocated till 3 months of age, if the testis remains non-palpable at 3 months of age, it is unlikely to become palpable by waiting another 3 months. Therefore, diagnostic laparoscopy and orchidopexy could be performed from 3 months of age(2). For intraabdominal cryptorchidism, laparoscopic surgery has been accepted by most surgeons as the preferred technique for diagnosis & treatment (4). Laparoscopic findings in non-palpable testis include ; Absent testis either ; Agenesis ( absence of spermatic vessels and vas deferens ) or vanishing testis ( blind ending of spermatic vessels or vas ) , Canalicular testis ; Penetration of vas and spermatic vessels into the internal inguinal ring with or without directly seeing the testis , Abdominal testis Localized between the inferior renal pole and the ipsilateral internal inguinal ring. Can be low (< 2cm) or high (>2cm) from internal inguinal ring , Peeping ; Primarily in intra-abdominal position. The testis introduces itself into the inguinal canal due to the intra-abdominal pressure augmentation during the laparoscopic procedure.(5) Several techniques have been described for treatment of intra-abdominal testis including microsurgical auto-transplantation, primary laparoscopic orchiopexy (VILO), one- and two-stage laparoscopic Fowler-Stephens procedures, and staged laparoscopic traction orchiopexy (Shehata technique

Official Title
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Role of Laparoscopy in Management of Non-palpable Undescended Testis : Assuit University Experience

Conditions
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Undescended Testes

Intervention / Treatment
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* Procedure: Laparoscopy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: any patient admitted to pediatric unit in Assuit University hospital with non palpable testis ( NPT )below age of 6 years Exclusion Criteria: patients with NPT above age of 6 years patients with atrophic or vanishing testis patients with previous failed laparoscopic orchiopexy

Ages Eligible for Study
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Minimum Age: 3 Months
Maximum Age: 6 Years

Sexes Eligible for Study
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Male

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Interventional Model Description: Prospective & retrospective
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: Laparoscopy<br>Diagnostic and therapeutic laparoscopy | Procedure: Laparoscopy<br>* Laparoscopic orchiopexy<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Testicular volume | Achievement of near normal testicular volume | 3 months postoperative | 
| Testicular position | Achievement of of near normal testicular position (at scrotum ) | 3 months postoperative | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Postoperative complications | Bleeding , damage of vas and/or blood supply and reascent | 3 months postoperative |