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Importance of scrotum pulling during diagnostic laparoscopy for impalpable testis

 Young Jae Im  ;  Hyun Jin Jung  ;  Yong Seung Lee  ;  Sang Woon Kim  ;  Sang Won Han 
 INTERNATIONAL JOURNAL OF UROLOGY, Vol.22(4) : 400-403, 2015 
Journal Title
Issue Date
Child ; Child, Preschool ; Cryptorchidism/diagnosis* ; Cryptorchidism/surgery* ; Diagnostic Techniques, Surgical ; Gonadal Dysgenesis, 46,XY/diagnosis ; Humans ; Infant ; Inguinal Canal/surgery* ; Laparoscopy/methods* ; Male ; Motion ; Prospective Studies ; Scrotum/surgery* ; Spermatic Cord ; Testis/abnormalities ; Vas Deferens
cryptorchidism ; laparoscopy ; orchiopexy ; scrotum ; vanishing testes
OBJECTIVES: To evaluate the significance of a scrotum pulling maneuver during diagnostic laparoscopy for impalpable testis in order to determine whether an initial scrotal or inguinal incision should be carried out. METHODS: A total of 75 patients undergoing diagnostic laparoscopy were included in the present study. If the vas deferens and spermatic vessels were noted to enter the internal inguinal ring, the affected scrotum was pulled downwards and the movements of the cord structures were observed. If inferior movement of the cord structures at the internal inguinal ring were noted, a scrotal approach was preferred. In the absence of cord structure movement, an inguinal approach was carried out first. RESULTS: In 59 (76.6%) out of 77 impalpable testes, the spermatic vessels and vas deferens were noted to enter the internal inguinal ring. In 41 of the 59 cases (69.5%), the cord structures were observed to move inferiorly when the scrotum was pulled downwards. In these cases, a scrotal incision was carried out first. In 97% (40/41), a nubbin testis was found and was then excised. In 23% (18/59), the cord structures did not move on pulling the scrotum, and an inguinal approach was initially carried out on these cases. A viable testis was found on the inguinal canal in four cases, and a nubbin testis was excised in 14 cases. CONCLUSIONS: In patients with impalpable testis undergoing diagnostic laparoscopy, identification of spermatic cord movement along the internal inguinal ring while pulling the scrotum downwards determines the most appropriate surgical approach. This maneuver might also prevent inappropriately placed skin incisions.
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1. College of Medicine (의과대학) > Dept. of Urology (비뇨의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Sang Woon(김상운) ORCID logo https://orcid.org/0000-0002-5790-1948
Lee, Yong Seung(이용승) ORCID logo https://orcid.org/0000-0003-3778-9888
Im, Young Jae(임영재)
Jung, Hyun Jin(정현진)
Han, Sang Won(한상원) ORCID logo https://orcid.org/0000-0003-0941-1300
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