Non-palpable testicle--the role of laparoscopy

We report our experience with 133 children treated laparoscopically for non-palpable testis during the last eight years. Diagnostic laparoscopy eventually combined with orchiectomy, for atrophic testicle, was performed in 59 patients. An apparently normal-sized intra-abdominal testicle was found in 74 patients, ten of whom were bilaterally affected. In 21 children, whose testicle were located in the vicinity of the internal ring, immediate laparoscopic-assisted orchidopexy was carried out. All other 53 children underwent two-stage Fowler-Stephens laparoscopic orchidopexy, only four of whom developed testicular atrophy. New insight concerning germ cell maturation dictates a revised protocol of hormonal therapy followed by early surgical intervention. Hopefully, this will further improve the superior outcome reported herein, similar to that in most of the recent series, which have established the laparoscopic management of non-palpable testicles as "state of the art".