Laparoscopic Management of the Testicular Remnant Associated with the Vanishing Testis Syndrome

Douglas Storm*, Brant R Fulmer, Joel Sumfest
Geisinger Medical Center, Danville, PA

Introduction: Management of testicular remnant associated with the vanishing testis syndrome (VTS) is controversial. The authors review the laparoscopic management of this condition to determine the most effective approach for handling the testicular remnant.
Methods: Retrospective review was performed on all patients undergoing excision of testicular remnant after laparoscopy revealed the vas and spermatic vessels entering a closed internal ring. Fifty patients, ages 10 to 216 months, underwent excision of the testicular remnant between 1994 and 2004. All pt had testis removed via a laparoscopic approach. Pathologic examination was performed on all specimens with attention to presence of germ cells, seminiferous tubules, vas deferens, epididymis, and spermatic vessels.
Results: All remnants were successfully removed in an outpatient setting. One patient developed a small scrotal hematoma managed conservatively. In total, 9 of 50 patients (18%) had identifiable germ cells in the testicular remnant. An additional 4 patients (8%) were found to contain seminiferous tubules without germ cells.
Conclusions: A significant percentage of testicular remnants in the VTS can harbor germ cells. The fate of these residual germ cells remains unknown; however there is an increased risk of testis cancer in the undescended testis. Our data shows that the testicular remnants can be excised laparoscopically with little morbidity, and we believe that this is the optimal approach in this clinical situation.

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