Editing AUA: Cryptorchidism (2018) (section)

==== Diagnostic laparoscopy ====

* '''<span style="color:#ff0000">Gold standard with high sensitivity and specificity'''
* '''Indications'''
** '''All nonpalpable unilateral''' 
** '''Many bilateral cryptorchid patients'''
* '''If a testis is found, the surgery continues and laparoscopic or open orchidopexy is completed, thereby providing diagnosis and therapy simultaneously'''
* '''<span style="color:#ff0000">Technique'''
** '''<span style="color:#ff0000">Goal is to identify testicle'''
***'''<span style="color:#ff0000">Exhaustive search from the level of the kidney to the internal ring'''
***'''<span style="color:#ff0000">If testis identified, decide to proceed with either orchidopexy or orchiectomy'''
****'''<span style="color:#ff0000">Orchiectomy'''
*****'''<span style="color:#ff0000">Situations where orchiectomy may be preferred in the presence of a normal contra-lateral descended testis (4)'''
*****#<span style="color:#ff0000">'''Atretic and/or short vas deferens'''
*****#<span style="color:#ff0000">'''Very short testicular vessels that place the testis high within the retroperitoneum'''
*****#<span style="color:#ff0000">'''Dysmorphic testis'''
*****#<span style="color:#ff0000">'''Testis in a postpubertal male'''
*****If an orchiectomy is performed, then the patient and family should be counseled about the importance of wearing protective gear during sporting activity.
****'''<span style="color:#ff0000">Orchidopexy'''
*****'''See below'''
** '''<span style="color:#ff0000">If no testis is identified, goal is identify the termination of the testicular vessels''' 
***'''<span style="color:#ff0000">Vessels may'''
****'''<span style="color:#ff0000">End blindly within the abdomen'''
*****'''When the vessels end blindly in the retroperitoneum, the surgeon may terminate the procedure or explore distal to the internal ring to confirm the absence of testicular tissue or remove a vanishing testis.'''
****'''<span style="color:#ff0000">Enter the internal ring'''
*****'''If vessels clearly enter the internal inguinal ring, must explore either the inguinal canal or the scrotum, depending on the surgeon's preference.'''
*****'''In cases of vanishing testes that have descended distal to the internal ring, the testicular vessels typically are less robust as they enter the internal ring as compared to the normal descended side.'''
*****After removing vanishing testis or nubbin, specimen should be sent for pathologic confirmation, to confirm a vanishing testis and no presence of malignancy
*** '''The identification of the vas deferens should not guide management as it is of distinct embryologic origin and may not be fused to the testis.'''