Pediatric urologyHistologic Evaluation of the Testicular Remnant Associated with the Vanishing Testes Syndrome: Is Surgical Management Necessary?
Section snippets
Materials and Methods
A retrospective review was performed of all consecutive patients undergoing diagnostic laparoscopy for a nonpalpable testis at Eastern Virginia Medical School and Geisinger Medical Center between 1994 and 2006. In our practice, if a testes is found to be nonpalpable on an initial examination performed during an office visit, then after receiving informed consent, all patients are scheduled for an examination under anesthesia. Provided that the examination under anesthesia confirms that the
Results
Between 1994 and 2006, 56 patients underwent laparoscopic removal of the testicular remnant associated with the vanishing testes syndrome. Patient age ranged from 11 to 216 months (median age 44.5 months). In no instance was a normal undescended testes encountered when the examination under anesthesia confirmed the nonpalpable nature of the testes. In 8 of the specimens (14%), we identified viable germ cell elements (Fig. 1). In an additional 4 patients (7%), we identified seminiferous tubules
Comment
Cryptorchidism is known to affect 3% of full-term male newborn infants and 0.8% of these male infants at 1 year of age. Twenty percent of all undescended testes are found to be nonpalpable.9 Elder further identified that 58% of nonpalpable testes are associated with spermatic vessels and a vas deferens exiting a closed internal inguinal ring. An additional 4% of nonpalpable testes were found to have blind ending spermatic vessels.4 Thus, 62% of nonpalpable testes may be associated with the
Conclusion
In our review, we identified that a significant number of testicular remnants associated with the vanishing testes syndrome can harbor viable germ cell elements or seminiferous tubules. The exact fate of these residual germ cells remains unknown; however, there is the potential for malignant transformation of these cells within the remnant. We believe that these remnants should be removed and this procedure may be accomplished with minimal morbidity via a minimally invasive approach.
References (9)
Avoidance of inguinal incision in laparoscopically confirmed vanishing testis syndrome
J Urol
(2001)- et al.
Laparoscopy for nonpalpable testes in childhood: is inguinal exploration also necessary when vas and vessels exit the inguinal ring?
J Urol
(1992) Laparoscopy for impalpable testes: significance of the patent processus vaginalis
J Urol
(1994)- et al.
Laparoscopic and histologic evaluation of the inguinal vanishing testis
Urology
(1998)