Case report: Primary carcinoid tumor of the testicle without metastases in combination with testicular atrophy and testosterone deficiency

The first case of testicular carcinoid was represented as an element of a benign cystic teratoma by Simon et al. J Urol 1954; 72: 892–894. It is a rare disease accounting for less than 1% of all testicular neoplasms. We report a case of carcinoid of the testis without carcinoid syndrome and metastasis but with testosterone deficiency based on a bilateral testicular atrophy, which has not been previously reported.     

Effects of follicular fluid administration on serum bioactive and immunoreactive FSH concentrations and compensatory testosterone secretion in hemicastrated adult rats

In adult rats, removal of one testis (hemicastration) results in an elevation of serum follicle-stimulating hormone (FSH) concentrations and a compensation in testosterone secretion by the remaining testis without a corresponding increase in testis size. To determine whether changes in FSH secretion and compensatory androgen production are related, serum testosterone concentrations were measured after inhibin-rich porcine follicular fluid was administered twice daily for 4 days to block the hemicastration-induced rise in FSH. Both serum immunoreactive FSH (immuno-FSH) and bioactive FSH (bio-FSH) concentrations were increased 4 days after hemicastration. The significant increase in serum immuno-FSH in hemicastrated animals was prevented by follicular fluid administration, whereas the serum bio-FSH activity and biologic to immunologic (B/I) ratios were increased in follicular fluid-treated animals. The follicular fluid-induced reduction in serum immuno-FSH had no effect on serum testosterone secretion in hemicastrated rats. Serum inhibin concentrations were reduced 27% in hemicastrated rats compared with intact controls, while administration of exogenous follicular fluid increased serum inhibin concentrations. An elevation in serum immuno-FSH secretion after hemicastration apparently is not required for the compensatory testosterone response. However, the observation of increased bio-FSH in hemicastrated and follicular fluid-treated animals raises questions about the importance of FSH quality (bioactivity), rather than quantity, for controlling testicular steroidogenic activity.     

Laparoscopic diagnosis and treatment of nonpalpable testis

OBJECTIVE: Laparoscopy has become one of the important diagnostic modalities of nonpalpable testis and has been developed and applied in the treatment of this disease. In the present study, we investigated the usefulness of laparoscopy in the diagnosis and treatment of nonpalpable testis. METHODS: Laparoscopy was carried out under general anesthesia on 21 patients (23 testes) from October 1991 to October 1999. If the internal spermatic vessels and vas deferens made their way into the internal inguinal ring, the inguinal canal was dissected with an incision in the inguinal region to look for the testis. Patients with intra-abdominal testis underwent laparoscopic orchiopexy or orchiectomy. If the internal spermatic vessels terminated with a blind end intraperitoneally, making it impossible to identify the testis, the case was judged to be vanishing testis and the operation was finalized without any further examination. RESULTS: In eight of 23 testes (35%), the internal spermatic vessels and vas deferens made their way into the internal inguinal ring. The inguinal region was examined in all the eight testes. Orchiopexy was carried out on two testes and orchiectomy was carried out on six testes. An intra-abdominal testis was detected in eight of 23 testes (35%). Laparoscopic orchiopexy was carried out on seven testes. One-stage orchiopexy was carried out on two of the seven testes and two-stage Fowler-Stephens orchiopexy was carried out on five of the seven testes. Orchiectomy was carried out on the remaining testis. Blocking or lack of the internal spermatic vessels and vas deferens was seen in seven of the 23 testes (30%) and this condition was diagnosed as vanishing testis. CONCLUSION: Laparoscopy for nonpalpable testis is considered to be the most effective technique for diagnosing the presence or absence of the testis and the location of the testis.     

Testicular atrophy after attempted pediatric orchidopexy for true undescended testis

Background/Purpose

A normal testis in the scrotum is the most important outcome of the attempted pediatric orchidopexy for a true undescended testis. The reports of post-orchidopexy testicular atrophy in the literature have ranged from non-existent to unclear. Our purpose in this study was to estimate the incidence of and associated risk factors for post-orchidopexy testicular atrophy.

Methods

We performed a retrospective review of data from children who had an attempted orchidopexy for a true undescended testis from 1969 to 2003 inclusive. REB approval 1000011987.

Results

There were 1400 attempted orchidopexies involving common (low) type (n = 1135), ectopic type (n = 174), and high type testes (n = 91). There were a total of 111/1400 (8%) atrophic testes, mostly right-sided. 66/111 (59%) were MADE atrophic, and 45 (41%) were FOUND atrophic. Of the 1135 common type, 56 (5%) were MADE atrophic. In the ectopic and high types, the incidence of post-operative testicular atrophy was 1% and 9%, respectively.The most significant risk factors associated with testes MADE atrophic were high testicle, vas problems, and pre-operative torsion.

Conclusions

In this series, the incidence of post-operative testicular atrophy that was MADE was 5% in the common (low) type and 9% in the high type. These numbers and the above risk factors should be quoted to the caregiver during pre-operative informed consent.     

Testis sparing surgery for the treatment of a sequential bilateral testicular germ cell tumor

Standard therapy of sequential bilateral testis cancer is generally considered to be orchiectomy. We present a case of sequential bilateral testicular germ cell tumor treated with testis sparing surgery. The patient was disease free 50 months after surgery without local recurrence or distant metastases. Testis sparing surgery provides a better quality of life and may be considered a safe, feasible alternative in the treatment of carefully selected patients with bilateral testicular germ cell tumor.     

Evaluation of Sperm Motility by Optical Diffractometry of Spermatograms

Evaluation of sperm motility based on analysis of spermatograms by optical diffractometry was performed. Spermatograms are defined as images of sperm tracks obtained on microphotographs by dark field illumination with long exposure time. Single track analysis proved that the details concerning single tracks are "seen" and recognized by the technique of optical diffractometry. Normal "linear", as well as abnormal "irregular", including "circular", tracks were numerically described. Multitrack analysis: The general pattern of all tracks contained in particular spermatograms derived from two groups of semen classified by hospital laboratory as "high" (control) and "low" ("mediocre") motility of spermatozoa, respectively, were analysed by optical diffractometry. The hospital laboratory was asked to provide for diffractometric analysis samples of the "mediocre" semens of quality similar enough to the "control" ones what concerns the percentage of motile spermatozoa (40 percent) and spermatozoan concentration. Diffraction patterns of 102 spermatograms of control sperm and of 103 spermatograms of sperm qualified as "mediocre" by subjective microscopic evaluation of sperm motility, were analysed and compared. Using discriminant analysis based on parameters describing radial distribution of light intensity in diffraction patterns of control and "mediocre" spermatograms, it was possible to classify correctly 71 cases as high motility sperms out of 102 spermatograms evaluated beforehand by hospital laboratory criteria as control ones. In the group of 103 spermatograms classified as "mediocre" sperms by hospital laboratory criteria 69 cases were correctly recognized as "mediocre" by diffractometric analysis. The overlapping of the analysed two groups of sperm by 30 percent might be explained by the fact that in the control spermatograms many trajectories are formed by inefficient, slow moving spermatozoa.(ABSTRACT TRUNCATED AT 250 WORDS)     

Protection of the solitary testis

In 15 negative explorations for unilateral cryptorchidism, inspection of the contralateral scrotum revealed a "bell-clapper" deformity in 13 patients. Since the descent of the testis is influenced by the gubernaculum and gubernacular abnormalities are usually bilateral, the data suggest that an inadequate gubernaculum is associated with most instances of antenatal and postnatal torsion. Unilateral absence of the testis is a form of this syndrome; congenital monorchidism is probably due to antenatal torsion rather than hypoplasia or agenesis. When monorchidism is confirmed at operation, exploration and suture fixation of the contralateral testis at the same procedure is recommended to protect the solitary testis from future torsion.     

Adenomatous hyperplasia of the rete testis: Report of two cases

We present two adenomatous hyperplasia of the rete testis (AHRT) cases. One of them was a 67-year old patient with prostatic adenocarcinoma and the other was a 38-year old patient with undescended testis. AHRT is a rarely seen lesion and usually detected as incidental microscopic finding. It may be confused with malignancy and related to testicular atrophy and hormonal imbalance.The treatment of choice is complete excision.     

Evaluation and treatment of the preadolescent varicocele

Varicocele is the most common surgically correctable cause of male infertility. In adult patients with varicocele and infertility, pregnancy rates following varicocelectomy range as high as 55 per cent in comparison with a pregnancy rate of only 7 per cent in unoperated controls. The initial presentation of varicocele occurs during puberty with the incidence in 13-year-old boys already equivalent to that in the general male population. This occurrence has been referred to as the childhood or adolescent varicocele. Varicocele is a progressive disorder in many if not in all cases, with an obvious individual variation in the time course of progression. The effects of a unilateral lesion are often noted in the contralateral testis. Based upon present knowledge, it is not possible to predict accurately the time course of progression in individual cases of childhood varicocele. However, significant prognostic features in adolescents with varicocele include the following: (1) testicular atrophy, or arrested testicular growth; (2) high-grade varicocele (grade II or III); (3) bilateral lesions; (4) pathologic GnRH stimulation test; and (5) histologic picture of Leydig-cell hyperplasia. The presence of these features either alone or in combination is an indication for treatment in our hands. Unlike adults with varicocele, it is not practical to follow children and adolescents with spermatograms.(ABSTRACT TRUNCATED AT 250 WORDS)     

腹腔型隐睾腹腔镜下二期Fowler-Stephens术的经验总结

目的探讨腹腔镜下二期Fowler-Stephens术（F-S术）治疗腹腔型隐睾的可行性。 方法回顾性分析2014年9月至2018年10月,南方医科大学附属南方医院和张家界市中医医院收治的35例（37侧）腹腔型隐睾患儿,其中29例（31侧）完成了二期F-S术,第2期手术后6个月复查彩色多普勒超声（随访28例,1例失访）,评估睾丸有无萎缩。 结果26例单侧腹腔型隐睾患儿中术侧睾丸血供正常22侧（84.62%）,睾丸直径≥1 cm,且位于阴囊内;术后出现睾丸萎缩4侧（15.38%）。2例双侧腹腔型隐睾患儿4侧（100%）术后均出现双侧睾丸萎缩。单双侧隐睾睾丸萎缩率比较,差异有统计学意义（P=0.003）。而睾丸萎缩率在不同年龄段和腹腔内睾丸距离内环口不同的距离之间,差异均无统计学意义（P>0.05）。 结论腹腔镜下二期F-S术治疗腹腔型隐睾,术后睾丸萎缩率不低,需要谨慎选择患者。对于睾丸位置位于内环口2 cm以内的腹腔型隐睾,直接行腹腔镜下一期睾丸下降固定术,减少术后睾丸萎缩的发生率。对于双侧腹腔型隐睾,可考虑分侧手术,如果一侧睾丸术后出现萎缩,那么另一侧就要考虑不离断精索血管的手术方式。     

A rare diagnosis： testicular dysgenesis with carcinoma in situ detected in a patient with ultrasonic microlithiasis

A rare case is presented where a dysgenetic testis with microinvasive carcinoma in situ （CIS, also known as intratubular germ cell neoplasm of unclassified type [IGCNU] and testicular intraepithelial neoplasia [TIN]） with microinvasion to rete testis and the interstitial tissue was found in a 32-year-old man presenting with mild scrotal pain and ultrasonic testicular microlithiasis. Knowledge of the association of ultrasound and CIS is important to diagnose patients at the stage prior to development of an overt germ cell tumor. The patient had three of four disorders considered symptoms of the testicular dysgenesis syndrome （TDS）： a dysgenetic left testicle with CIS, a mild left-sided cryptorchidism （high positioned scrotal hypotrophic testis） and a slightly reduced semen quality. Therefore, it should be kept in mind that a patient with one TDS symptom may harbour the other, even CIS or testicular cancer. Accordingly, patients with one TDS symptom ought to be examined for the presence of the others, and if more that one is present, extra concern is warranted.     

Clinical epidemiology of testicular germ cell tumors

Clinical epidemiology is sometimes called the basic science of clinical medicine. In terms of the pathogenesis of testicular germ cell tumors (GCTs), clinical epidemiology analyzes suspected risk factors. The present review highlights the risk factors established so far and briefly summarizes those factors currently under investigation. In analogy to the methods of evidence based medicine, this review attributes levels of evidence to each of the putative risk factors. Level I represents highest quality of evidence while level V denotes the lowest level. So far, undescended testis (UDT), contralateral testicular GCT and familial testis cancer are established risk factors attaining high levels of evidence (levels I–III a). In a meta-analysis of 21 studies exploring the association of UDT with GCT risk, an over-all relative risk (RR) of 4.8 (95% confidence interval 4.0–5.7) was found. Contralateral testicular GCT involves a roughly 25-fold increased RR of GCT, while familial testis cancer constitutes a RR of 3–10. Infertility, testicular atrophy, and twin-ship represent risk factors with lesser levels of evidence (level III a). There is also some evidence for HIV infection being a predisposing factor for GCT (level IV a). Scrotal trauma is probably not associated with GCT risk. The estrogen excess theory implies high estrogen levels during the first trimester of pregnancy. As a consequence, primordial germ cells lose track of the normal developmental line and transform into premalignant cells that later become testicular intraepithelial neoplasia (TIN), the precursor of full-blown testicular GCT. Surrogate parameters for high gestational estrogen levels are investigated in case control studies. Such factors are maternal age >30 years, first-born, low birth weight, maternal breast cancer, high sex-ratio of siblings. So far, the sum of evidence is promising but still conflicting (especially for level III b). Another novel theory is the childhood nutrition hypothesis. This concept postulates a modulating or catalyzing effect by high dietary intake during childhood on the pathogenesis of testicular GCT. A surrogate parameter of early childhood nutrition is adult height. So far, 12 controlled studies have looked to the possible association of attained height and GCT risk of which six demonstrated a significant association. Thus, the sum of evidence corresponds to level III b. This concept is appealing because it would explain several hitherto unexplained epidemiological features of GCT.     

Testicular lesions other than germ cell tumours: feasibility of testis-sparing surgery

OBJECTIVE

To review all non‐germ‐cell testicular lesions presenting at our institution and to determine the feasibility of testis‐sparing surgery for these patients.

PATIENTS AND METHODS

All surgery for testicular masses between June 1995 and June 2005 were reviewed retrospectively. Patients with atrophy, germ cell tumours, infection or torsion were excluded. The study comprised men who had radical orchidectomy for suspected germ‐cell tumour but had other final pathology, and those where testis‐sparing surgery was attempted for a presumed benign lesion.

RESULTS

Thirteen patients with lesions appropriate for the study were identified; all but one had a palpable lesion. The lesions could be categorized as inflammatory (three hyalinized fibrosis, two sarcoidosis, one chronic inflammation), cystic (one epidermoid cyst, one unilocular cyst), benign neoplasms (two adenomatoid tumours, one Leydig cell tumour, one capillary haemangioma) or malignant neoplasms (one lymphoma). Based on the preoperative impression, testis‐sparing surgery was attempted in eight of the lesions and was successful in six where it was attempted. In the other five, testis‐sparing surgery was not attempted because the preoperative impression was that of a germ cell tumour. Testis‐sparing surgery was successful in only six of the 13 patients with these lesions.

CONCLUSION

Testis‐sparing surgery might be possible if there is significant suspicion of a benign lesion. If frozen‐section analysis is equivocal, a radical orchidectomy is required. Testis‐sparing surgery was feasible in highly selected cases.     

Surgical findings in acquired undescended testis

Background/purpose

The aim of this study was to retrospectively review the findings at orchidopexy in acquired undescended testis (UDT).

Methods

The authors reviewed a 14-year (1986 through 1999) surgical experience in 360 boys in whom 461 orchidopexies were performed for acquired-UDT. The operative notes were reviewed to determine at operation testis position and volume, persistence of patent processus vaginalis (PV), and attachment of the gubernaculum. Also, testis position after orchidopexy was evaluated.

Results

Age at operation ranged from 2 to 19 years (mean, 8.9 years), 205 of the 461 orchidopexies (44.5%) had been performed between 9 and 12 years of age. In 327 of the 461 cases (70.9%), testis position was documented as intraoperative; in 281 of these cases (86.0%), the testis was located in the superficial inguinal pouch (SIP). A note was made regarding the presence or absence of a hernial sac in 207 of the cases: 113 (54.6%) were associated with an open PV, which usually was slightly open. In 122 of the 461 cases (26.5%), the gubernacular attachment was assessed; in 121 of these (99.2%), a normal attachment of the gubernaculum was noted. At the end of orchidopexy, in 438 of the 461 cases (95.0%), testis position was recorded. Three hundred eighty-two of these testes (87.2%) were at the bottom of the scrotum.

Conclusions

Acquired UDT usually is characterized by SIP position, closed or (small) open PV, and normal gubernaculum attachment. The results of surgery seem excellent.     

Differential expression of androgen and estrogen receptor of appendix testis in patients with descended and undescended testes

Objectives:   The incidence of appendix testis has been shown to be 76% in descended and 24% in undescended testis in our previous intraoperative survey. To determine the possible role of the appendix testis in the process of testicular migration, we compared the androgen and estrogen receptor status of appendix testis in descended and undescended testes.
Methods:   Thirty-seven appendix testes were collected intraoperatively and the expression of androgen and estrogen receptors were examined with immunostaining and immunofluorescence labeling. Based on the diagnosis, the specimens were divided into three groups. Group H (groin hernia, n  = 11, as a group of descended testis), Group AU (acquired undescended testis, n  = 14), and Group CU (congenital undescended testis, n  = 12).
Results:   The testicular appendages were found to express both androgen and estrogen receptors in Group H and Group AU, but specimens in Group CU were only estrogen receptor positive, whereas androgen receptors were not present.
Conclusion:   The presence of the androgen receptor in the appendix testis of the descended testes and acquired undescended testes and its absence in patients with congenital undescended testis suggests that the appendix testis might play a role in the process of testicular descent.     

Is the Fowler-Stephens procedure still indicated for the treatment of nonpalpable intraabdominal testis?

Purpose

There are no formal guidelines for the management of boys with nonpalpable testis. In this article, we report our experience in treating all nonpalpable intraabdominal testis (NPIT) with standard inguinal orchidopexy without dividing the spermatic vessels stating that the Fowler-Stephens technique is no longer indicated for the treatment of the intraabdominal testis.

Methods

Between June 2003 and April 2008, we treated 23 boys with NPIT confirmed by ultrasound or laparoscopy. All cases were treated through an inguinal orchidopexy without division of the spermatic vessels by fixing the testis to the scrotum by 2 absorbable stitches even if there was an upward retraction of the scrotal skin. Location and size of testis were reported at 1 week, 1 month, 3 months, and 6 months through physical examination.

Results

Average age at presentation was 24 months. Ten patients (43%) had the NPIT on the right side, 8 (35%) on the left side, and 5 (22%) were bilateral. We had no intraoperative complications. All patients were discharged on the same day. In all cases, the testis was normal in size and found in the scrotum after 6 months of follow-up.

Conclusion

On the basis of our experience, we believe that the Fowler-Stephens procedure is not indicated anymore in the management of NPIT. Orchidopexy without division of the spermatic vessels should be the treatment of choice even for the cases of very high intraabdominal testis because it does not affect normal testicular vascularization and is minimally invasive.     

Impact of laparoscopy on the management of an unusual case of nonpalpable testis in an adult patient

Background: In the past decade, cryptorchidism has generally been treated in the first 36 months of life using an inguinal approach, in the case of palpable testis, or using laparoscopy, in the case of nonpalpable testis. Nevertheless, before this period some children were managed incorrectly. This case report shows how laparoscopy and the collaboration between pediatric surgeons and urologists may lead to optimal results. Case report: A 19-year-old male was referred to our unit following routine medical examination for enrollment in the military service with a diagnosis of right cryptorchidism. The clinical history showed the anamnesis of right cryptorchidism diagnosed at birth as a right nonpalpable testis, confirmed at 2 years of age with clinical examination and computer tomography. The patient came to our attention to again undergo a clinical examination, ultrasonography, computed tomography, and magnetic resonance imaging. We found a left, well-positioned testis of 20 ml in volume and an empty right scrotum; all the instrumental examinations were negative. The patient was thus scheduled for a diagnostic laparoscopy. A pediatric surgeon with extensive experience in this pathology performed the procedure. The 10-mm 30° optics introduced through the umbilicus showed a closed right inguinal ring, with no evidence of either vas deferens or inner spermatic vessels at the level of the inguinal region or pelvis. Two more trocars were introduced and a testis of 15 ml in volume was found under the ascending colon 10 cm away from the cecum. An orchiectomy was performed via laparoscopy. Conclusion: This case clearly shows that some males with nonpalpable testis may have been treated incorrectly in the prelaparoscopic era and may now have an intraabdominal testis. In addition, our experience shows that intraabdominal testis may sometime be in an unusual location, and a laparoscopic surgeon with experience in this pathology is fundamental to finding the testis. In the case of adults with nonpalpable testis, when echography, computed tomography, and magnetic resonance imaging are not useful, the only effective diagnostic procedure is laparoscopy.     

The effects of unilateral testicular ischemia and hemicastration on contralateral testicular IGF-1 level,histology and lipid peroxidation

Hemicastration is followed by compansatory hypertrophy whereas unilateral testicular torsion is followed by atrophy in contralateral testicle in rats. Insulin-like growth factor (IGF-1) has important roles in testicular paracrine and autocrine functions. In this study it was aimed to compare ischemic parameters and IGF-1 levels in the contralateral testicle in unilateral spermatic cord ligation, testicular torsion, and hemicastratron. 32 wistar rats were equally altocated into sham, ligation, torsion, and hemicastration groups. In ligation group, right spermatic cord was ligated with 3/0 silk suture. In the torsion group, right testis was tcrsed for 720 degrees. In hemicastration group, right orchiectomy was done. 48 hours later left orchiectomy was done in all groups. Malondialdehyde (MDA) and IGF-1 levels were determined in the testicle. Average values of the groups were compared with Anova followed by Dunnett T3 multiple comparison tests. MDA levels were significantly reduced in ligation and torsion groups (p < 0.05). This reduction was more prominent in hemicastration group (p < 0.05). Contralateral testicular IGF-1 levels in ligation and torsion groups were not different compared with the sham group. Left testicular IGF-1 level in the hemicastration group was decreased significantly compared with other groups (p < 0.05). Histological. changes evaluated. Contralateral Johnsen's testicular biopsy scores were significantly decreased in all experimental groups but mean tubular diameter was not changed in all groups.     

Laparoscopic orchiectomy for the adult impalpable testis – experiences in a rural teaching hospital

Background Undescended testis is a relatively common condition in boys. The standard treatment is orchiopexy. In adults, orchiopexy is done only if sufficient length can be mobilized. Otherwise, orchiectomy is ideal as undescended testis predisposes to carcinoma. The incidence of carcinoma increases with age. The aim of this study is to highlight the value of laparoscopy in treatment of impalpable testis and simultaneously repair associated hernias. This is our experience in a rural tertiary hospital. Methods In our rural hospital, it is not uncommon to see men aged 30 years or more presenting with unilateral absence of testis/empty hemiscrotum. A total of 35 patients were studied. Ultrasonography of the abdomen was done to localize the exact position of the testis; it was detected in 12 cases. A computed tomography (CT) scan was done in the other 23 cases and was positive in 16. The testis was found in the retroperitoneum (close to the internal inguinal ring) in 12 cases and in the inguinal canal in 23 cases. There were associated hernias in 9 patients. Results Laparoscopy accurately identified the exact location of the missing testis and resection was also accomplished and associated hernias were repaired laparoscopically. Discussion In countries like India, the majority of the population is poor and illiterate. By the time a boy or young man with an undescended testis arrives at the hospital, it is already too late to do orchiopexy. Even though most of our patients had no symptoms, orchiectomy had to be done because of the risk of torsion and malignant transformation. By using laparoscopy in these patients, the advantages of minimally invasive surgery can be utilized. Conclusions Laparoscopic orchiectomy seems to be advantageous and well received by patients. We preferred the laparoscopic approach for the obvious benefits of less pain, better cosmesis, and early discharge.     

How well does contralateral testis hypertrophy predict the absence of the nonpalpable testis?

PURPOSE: We assessed the accuracy of contralateral testis hypertrophy for predicting monorchia in patients with a nonpalpable testis. MATERIALS AND METHODS: From May 1993 to September 1998 we evaluated 60 patients 7 months to 11 years old for a unilateral nonpalpable testis. Four patients were excluded from study who had received human chorionic gonadotropin or had signs of puberty. We correlated contralateral testis hypertrophy, defined as testis volume greater than 2 cc or testis length greater than 2 cm., with presence or absence of the nonpalpable testis. We also recorded the degree to which contralateral testis length less than 2.1 cm. correlated with the presence or absence of the nonpalpable testis. Laparoscopy and open exploration were performed in 52 and 4 cases, respectively. RESULTS: Contralateral testis hypertrophy greater than 2 cm. was noted in 16 patients, including 14 (87.5%) with monorchia and 2 (12.5%) with an intra-abdominal testis. Of the 15 patients with a contralateral measurement of 1.8 to 2.0 cm. 14 had monorchia (93%) and 1 had a tiny ovotestis. Of the 25 patients with a contralateral measurement of less than 1.8 cm. 13 (52%) had testes that were intra-abdominal in 11 and canalicular in 2. The optimal cutoff value for contralateral enlargement was 1.8 cm. (p = 0.00061). The most common laparoscopic finding in patients with contralateral testis hypertrophy greater than 2 cm. was blind ending vessels proximal to the internal ring in 56%. CONCLUSIONS: Contralateral testis hypertrophy is common in patients with a nonpalpable testis. Hypertrophy 1.8 cm. or greater predicts monorchia with an accuracy of about 90%. The finding of contralateral testis hypertrophy provides useful information for preoperative counseling, allowing us to inform parents that the nonpalpable testis is most likely absent. Exploration is still required. Laparoscopy is particularly advantageous in contralateral testis hypertrophy since it was the only procedure required in about half of our cases.