The presence or absence of an impalpable testis can be predicted from clinical observations alone

Abstract

Objective To evaluate, in a prospective study, the accuracy of predicting the presence or absence of unilateral or bilateral impalpable testes from a clinical examination, particularly whether the contralateral descended testis (CDT) is hypertrophied. Patients and methods Whether the ipsilateral scrotal appendages were palpable, and the size of the CDT, were determined before surgery in a series of patients, and compared with age-matched controls. Between 1992 and 2000, 100 impalpable testes in 86 consecutive patients (mean age at orchidopexy 45 months, range 6-223; 66% <36 months) were evaluated and treated. In addition to the presence or absence of palpable ipsilateral scrotal appendages, the size of the CDT, when present, and the intraoperative findings were recorded. Logistic regression analysis was used to model the probability of the presence or absence of the testis, as determined by the preoperative clinical findings alone. Results Of the 86 testes that were located at surgery, 50 (58%) were intracanalicular, 28 (32%) intraabdominal and the remainder (10%) were in the superficial inguinal pouch. Of 13 patients with the 'vanishing testis syndrome', the atrophic testicle was intracanalicular in nine, in the upper scrotum in three and intra-abdominal in only one. All viable testes were successfully relocated in the scrotum, with one atrophic after surgery. The positive predictive value (PPV, with 95% confidence interval) of a testis being present when the ipsilateral appendages were palpable and the CDT was not hypertrophied was 0.93 (0.83-0.97). Conversely, the PPV of the impalpable testis being absent when the appendages were impalpable and the CDT was hypertrophied was 0.95 (0.64-0.99). Conclusion When evaluating and surgically treating impalpable testes, the presence of palpable ipsilateral scrotal appendages and a CDT with no hypertrophy is associated with a 93% likelihood of discovering a testis that can be successfully relocated to the scrotum. Conversely, when the ipsilateral scrotal appendages cannot be palpated and the CDT is hypertrophied, there is a 96% probability that the impalpable testis is absent (vanishing testis syndrome). This readily available information may be valuable in preoperative counselling and planning.

Current management of non-palpable testes: a literature review and clinical results

“…Hypertrophic contralateral teste could be correlated with absent teste or atrophy (12,13). Nevertheless, this does not preclude surgical exploration since the sign of compensatory hypertrophy is not specific enough (14).…”

Testicular hypertrophy as a predictor for contralateral monorchism: Retrospective review of prospectively recorded data

“…It was a retrospective study with a prospectively collected testicular measurements data. The study included a relatively small number of patients; however, it compared favorably with other studies [9][10][11][12][13]20,21]. Measurement of the testicular size using the orchidometer is less accurate than the ultrasound.…”

“…They estimated the cut-off value to be 1.8 cm [10]. Mesrobian et al used a ruler for measurement of contralateral testis and defined hypertrophy to be more than 2 SD above the normal mean volume [9]. Snodgrass et al used a ruler to measure the testicular length.…”

“…Contralateral testicular hypertrophy has been shown as a good predictor for monarchism [8][9][10][11][12]. Testicular hypertrophy is a physiological response to the absence of the other testis for physical maturation and sexual development [8].…”

Abordaje Laparoscópico en el Testículo no Palpable

“…En cuanto al examen físico, su sensibilidad es dependiente de la experiencia del examinador, la morfología del paciente y la localización testicular 4,6 . El hallazgo de un teste descendido hipertrófico contralateral podría correlacionarse con ausencia de teste no palpable, pero este fenómeno bien documentado varía con la edad, el volumen total de tejido testicular presente y con la calidad del tejido descendido 10 . Se ha descrito que de los pacientes con TNP, existe cerca de un 18% que en el EBA se logra palpar un testículo 6 .…”