LAPAROSCOPIC GRADUAL TRACTION OF THE TESTICULAR VESSELS IN CASE OF IMPALPABLE UNDESCENDED TESTES

Most undescended testes are palpable, but around 20% of cases are reported as non-palpable, and these represent a major challenge as regards determining the most effective strategy for diagnosis and treatment. About 3% of full-term and 30% of premature infant boys are born with at least one undescended testis; making cryptorchidism the most common birth defect of male genitalia . The aim of work is to evaluate a newly described vessel sparing technique (gradual traction method) for treatment of high impalpable undescended testes and to assess value of laparoscopy in diagnosis and treatment of various types of impalpable undescended testes.Patient and methods: This study included 28 patientswho presented with 30 impalpable testes to the outpatient clinic of fayoum university hospital in July 2013- January 2016, and underwent laparoscopy by the same surgeons. Intra-abdominal testes were managed by standard inguinal orchiopexy if intracanalicular or peeping, laparoscopic orchiopexy if low and staged traction (Shehata technique) if high. Children were evaluated postoperatively to check the location and size of the testicle and to exclude any other complications. Results: Mean age at presentation was 8.90years (range 1-20years). Follow up was 6-18 months (mean 10 months). On follow up, the testes were normal sized and well positioned in the scrotum in all testes in the orchiopexy and traction groups with an overall success rate of 100%. One testis slipped off the traction stitch and was converted to a staged Fowler-Stephens procedure.Conclusion: For high level undescended testis and when one-stage mobilization is difficult, staged traction orchiopexy (Shehata technique) has excellent results.