Scrotal-inguinal ultrasonography: A technique for identifying the nonpalpable inguinal testis without laparoscopy

Purpose: Treatment of the patient with a nonpalpable testis is controversial, since a high percent will have an inguinal testis or testicular remnant at exploration. While laparoscopy is an effective modality for localizing the intra-abdominal testis, diagnostic laparoscopy is of limited value for patients with nonpalpable (normal or atrophic) inguinal testes. In an effort to identify preoperatively impalpable inguinal testes, we performed scrotal-inguinal ultrasound. Materials and Methods: We evaluated 64 patients (74 nonpalpable testes) in the last 4 years, representing 20% of all those presenting with cryptorchidism. Average patient age was 4.5 years (range 6 months to 17 years). All patients underwent preoperative scrotal-inguinal ultrasound and surgical exploration. Diagnostic laparoscopy was reserved for patients with negative ultrasound and no palpable tissue in the scrotum or groin on a preoperative examination. Results: Scrotal-inguinal ultrasound correctly identified 40 of the 42 inguinal testes (95% sensitivity), 7 of the 21 atrophic inguinal testes (33% sensitivity) and 1 of the 11 intra-abdominal testes (9% sensitivity). Therefore, scrotal-inguinal ultrasound correctly identified an inguinal testis or remnant for 47 of the 74 nonpalpable testes (64%), eliminating the need for diagnostic laparoscopy in those cases. For 26 of 74 nonpalpable testes with negative ultrasound 13 had an associated palpable inguinal or scrotal nubbin of tissue, and inguinal exploration only was performed, resulting in 9 orchiectomies, 2 inguinal orchiopexies and 2, 2-stage orchiopexies. Of the 13 nonpalpable testes without palpable nubbins and negative scrotal-inguinal ultrasound 8 were intra-abdominal and 5 were atrophic inguinal testes. Conclusions: Scrotal-inguinal ultrasound identifies patients with nonpalpable testes who will maximally benefit from diagnostic laparoscopy. When diagnostic laparoscopy was limited to nonpalpable testes without palpable nubbins and negative scrotal-inguinal ultrasound, only 13 of 74 (18%) required laparoscopy. Inguinal exploration without further diagnostic studies is appropriate for boys with nonpalpable testes and palpable nubbins.