LOCALIZATION OF NON-PALPABLE TESTIS IN CHILDHOOD: MAGNETIC RESONANCE IMAGING VS LAPAROSCOPY

Document Type : Original Article

Authors

1 Departments of Radiology, Faculty of Medicine, Zagazig University

2 General Surgery, Faculty of Medicine, Zagazig University.

Abstract

Laparoscopy and magnetic resonance imaging (MRI) are competitive tools in the diagnosis of non-palpable testis. A 
prospective evaluation to determine the accuracy of MRI vs laparoscopy in the detection of undescended non-palpable testis 
was performed in 13 boys with 15 non-palpable testes. The results were compared between MRI, laparoscopy and definitive 
surgical diagnosis in all patients. MRI have reached a correct diagnosis in 13 out 15 non-palpable testes (86.6%). Three testes were located intra-canalicular, 5 were located just-canalicular, 3 were located intra-abdominal on the sides of urinary bladder. In the other 2/13 cases MRI showed small poorly defined testes with low signal intensity on both T1 and T2-weighted images indicative of fibrotic changes. These 2 testes proved to be atrophic after surgical exploration. MRI failed to detect or localize undescended non-palpable testis in 2 cases. 
On the other hand, initial laparoscopy revealed 5 testes to be intra-abdominal, and another 5 testes to be justcanalicular. Laparoscopy diagnosed inguinal testis in 3 instances, in which the vas and vessels were seen entering an open internal ring. In another 2 cases, the vas and vessels have entered a closed internal ring, they were diagnosed as vanished or atrophic testes in the inguinal canal. 
We recommended the use of non-invasive, non-ionizing MRI initially for all children with non-palpable testes to locate 
normal or atrophic testis, as a positive MRI finding locates the testis reliably, and limit minimally invasive diagnostic 
laparoscopy to patients with negative MRI findings. 

Keywords

The Egyptian Journal of Surgery
Volume 19, Issue 4
October 2000
Pages 328-336

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