Absent Testis in Scrotum

Vivek Rege
Absent Testis in Scrotum - Complications
The problems occur in those boys where I am unable to feel a testis. This could mean that the testis is in the inguinal canal but cannot be felt, the testis could be in the abdomen and hence it cannot be felt, it could have undergone torsion during life and has become small and atrophic hence is not felt, or lastly, the testis could be absent. Differentiating one from the other requires the use of investigations. The first is a simple easily available and non invasive:

Ultrasonography: This will show the site of the testis clearly if it is in the inguinal region, its dimensions if normal, the previously described operation can be successfully carried out. The testis may be visualized in the inguinal region but may be seen to be small atrophic "possible previous torsion" in such cases during the operation it is advisable to remove the testis rather than keeping a useless testis in the scrotum and let it affect the function of the opposite normal testis.

It may be that the testis is in the abdomen or just inside the canal, but due to technical reasons may not be visualized by Sonography. Hence, non-visualized testis should not be taken as absent testis because time and again I have explored the inguinal region and found a testis of a good size in 8 out of 10 such boys.

With rapid advances in technology today, I would first do a diagnostic Laparoscopy. This is introduction of a Pediatric Laparoscope thru a small 5mm hole made just at the umbilicus and the scope is put inside the abdominal cavity and the side of the missing testis is visualized - three things may be seen 1.The blood vessels and the vas deferens can be seen going into the inguinal canal this means that the testis is present and is in the inguinal canal and can be tackle like previously described and brought down easily. There may be a possibility that the testis is in the inguinal canal but is small and atrophic and hence was not seen on sonography and if so then that testis needs to be removed.

2.The testis may be seen just at the internal ring or higher up. The vessels and the vas are identified and either a one stage mobilization of the testis or a 2 stage procedure is done to bring the testis down into the scrotum.

3.In rare cases no vas, vessels or the testis is visualized within the abdomen this is confirmatory of an absent testis. No further procedure is required.

The possible complications of this surgery are damage to the vas or the vesssels during handling which can cause rupture or permanent damage to the blood supply or the passage of the sperms into the urethra. This will only be known much later in life after the boy has got married and is unable to conceive a child. Another complication is mechanical - the testis that is brought down to the scrotum is not adequately fixed and can slip back upwards.

Laparoscopic view of vas and vessels
Laparoscopic view of vas and vessels

Laparoscopic view of testis in abdomen
Laparoscopic view of testis in abdomen

Absent Testis in Scrotum Absent Testis in Scrotum 01/03/2001
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