• Nadeem Iqbal Shifa International hospital Islamabad.Pakistan.
  • Aisha Hasan Riphah International University,Rawalpindi.
  • Sumera Saghir Avicenna Medical College,Lahore.
  • Sidra Iqbal shifa international hospital Islamabad,Pakistan.
  • Usama bin Saif shifa international hospital Islamabad,Pakistan.
  • Alia Mohsin Choudhry shifa international hospital Islamabad,Pakistan.
  • Ali Mohsin Choudry shifa international hospital Islamabad,Pakistan.
  • Behzad Saeed Gill shifa international hospital Islamabad,Pakistan.
  • Ijaz Hussain shifa international hospital Islamabad,Pakistan.
  • Daud Iqbal Registrar Cardiology Faculty Ayub Teaching Hospital
  • Faheemullah Khan Hyatabad Medical Complex
  • Saeed Akhter shifa international hospital Islamabad,Pakistan.


Background: Despite numerous clinical studies regarding the management of unilateral impalpable testes by laparoscopy, there is a paucity of such studies regarding the management of bilateral ‘non-palpable’ testes. We shared the outcome of the laparoscopic management of bilateral ‘non-palpable’ testes in terms of successful orchiopexy and complications in children. Methods: A total of 22 children underwent bilateral diagnostic laparoscopy for undescended testes who presented to our department from January 2010 till March 2018. We did chart review for variables such as the age of children, operative time, hospital stay, single stage or 2 stage procedure, and operative complications. Preoperatively history and physical examination was done along with baseline investigations and Ultrasound abdomen and scrotum before surgery for general anaesthesia fitness. They were managed by single or two steps laparoscopic orchiopexy according to suitability for each case. Results: We performed bilateral laparoscopic orchidopexies in 22 children having a mean age of 4.1±1.98 years (49.2 months) Mean operative time for single setting bilateral single stage orchiopexy was 136±32 minutes. Out of twenty-two children with bilateral impalpable testes, 12 boys (54.5%) were managed with a single stage Bilateral Laparoscopic technique while the other 10 (45.45%) were managed in 2 staged laparoscopic intervention using Fowler-Stephens technique. Testicular atrophy was seen in 2/44 testes (4.54%). While 1 /44 (2.27%) testis had ascended to the inguinal region requiring redo surgery. Conclusion: Laparoscopic management of bilateral ‘non-palpable’ testes in a single or double setting is a safe and effective method of bringing testes down to the scrotum. It has no major morbidities.Keywords: Children; Intra abdominal testis; Laparoscopic Orchidopexy

Author Biography

Nadeem Iqbal, Shifa International hospital Islamabad.Pakistan.

Post graduate trainee urology at shifa international hospital Islamabad,Pakistan.


Esposito C, Caldamone AA, Settimi A, El-Ghoneimi A. Management of boys with nonpalpable undescended testis. Nat Clin Pract Urol 2008;5(5):252–60.

Kalfa N. Commentary to "Management of undescended testes: European Association of Urology/European Society for Paediatric Urology Guidelines". J Pediatr Urol 2016;12(6):345–6.

Wood HM, Elder JS. Cryptorchidism and testicular cancer: separating fact from fiction. J Urol 2009;181:452–61.

Kolon TF, Herndon CD, Baker LA, Baskin LS, Baxter CG, Cheng EY, et al. Evaluation and treatment of cryptorchidism: AUA guideline. J Urol 2014;192(2):337–45.

Guminska A, Oszukowska E, Kuzanski W, Sosnowski M, Wolski JK, Walczak-Jedrzejowska R, et al. Less advanced testicular organogenesis is associated with a higher incidence of germ cell neoplasia. Int J Androl 2010;33(1):e153–62.

Gurney J, Richiardi L, McGlynn K, Signal V, Sarfati D. Analgesia use during pregnancy and risk of cryptorchidism: a systematic review and meta-analysis. Hum Reprod 2017;32(5):1118–29.

Hutson JM, Li R, Southwell BR, Petersen BL, Thorup J, Cortes D. Germ cell development in the postnatal testis: the key to prevent malignancy in cryptorchidism? Front Endocrinol (Lausanne) 2013;3:176.

Canning DA. Re: Outcome of Bilateral Laparoscopic Fowler-Stephens Orchidopexy for Bilateral Intra-Abdominal Testes. J Urol 2015;194(1):201.

Moursy EE, Gamal W, Hussein MM. Laparoscopic orchiopexy for non-palpable testes: outcome of two techniques. J Pediatr Urol 2011;7(2):178–81.

Kucharski P, Niedzielski J. Neoadjuvant human Chorionic Gonadotropin (hCG) therapy may improve the position of undescended testis: a preliminary report. Cent Eurropean J Urol 2013;66(2):224–8.

Cortesi N, Ferrari P, Zambarda E, Manenti A, Baldini A, Morano FP. Diagnosis of bilateral cryptorchidism by laparoscopy. Endoscopy 1976;8(1):33–4.

Anwar AZM, Fathelbab TK, Abdelhamid AM, Galal EM, Ali MM, Tawfiek ER. Initial laparoscopy and optimized approach for unilateral nonpalpable testis: review of 8-year single-center experience. Int Urol Nephrol 2018;50(12):2139–44.

Elyas R, Guerra LA, Pike J, De Carli C, Bettolli M, Bass J, et al. Is staging beneficial for Fowler-tephens orchiopexy?A systematic review. J Urol 2010;183(5):2012–8.

Lin CC, Huang WJ, Chen KK. Measurement of testicular volume in smaller testes: how accurate is the conventional orchidometer? J Androl 2009;30(6):685–9.

Chung E, Brock GB. Cryptorchidism and its impact on male fertility: a state of art review of current literature. Can Urol Assoc J 2011;5(3):2010–4.

Niedzielski JK, Oszukowska E, Słowikowska-Hilczer J. Undescended testis-current trends and guidelines: a review of the literature. Arch Med Sci 2016;1;12(3):667–77.

Chang B, Palmer LS, Franco I. Laparoscopic orchidopexy: a review of a large clinical series. BJU Int 2001;87(6):490–3.

Ramareddy RS, Alladi A, Siddappa OS. Ectopic testis in children: experience with seven cases. J Pediatr Surg 2013;48(3):538–41.

Powell C, McIntosh J, Murphy JP, Gatti J. Laparoscopic orchiopexy for intraabdominal testes-A single institution review. J Laparoendosc Adv Surg Tech A 2013;23(5):481–3.

Ritzén EM. Undescended testes: a consensus on management. Eur J Endocrinol 2008;159(Suppl 1):S87–90.

Ansari MS, Mandal S, Ray R, Hemal AK. Bilateral cryptorchidism with bilateral inguinal hernia and retrovesical mass in an infertile man: single-stage laparoscopic management. J Laparoendosc Adv Surg Tech A 2002;12(1):73–5.

Taran I, Elder JS. Results of orchiopexy for the undescended testis. World J Urol 2006;24(3):231–9.

Safwat AS, Hammouda HM, Kurkar AA, Bissada NK. Outcome of bilateral laparoscopic Fowler-Stephens orchidopexy for bilateral intra-abdominal testes. Can J Urol 2013;20(5):6951–5.

Kaye JD, Palmer LS. Single setting bilateral laparoscopic orchiopexy for bilateral intra-abdominal testicles. J Urol 2008;180(4 Suppl):1795–9.

Abbas TO, Hayati A, Ismail A, Ali M. Laparoscopic management of intra-abdominal testis: 5-year single-centre experience-a retrospective descriptive study. Minim Invasive Surg 2012;2012:878509.

Wang CY, Wang Y, Chen XH, Wei XY, Chen F, Zhong M. Efficacy of single-stage and two-stage Fowler-Stephens laparoscopic orchidopexy in the treatment of intraabdominal high testis. Asian J Surg 2017;40(6):490–4.



Most read articles by the same author(s)

<< < 1 2