Lost and found testes: The importance of the hCG stimulation test and other testicular markers to confirm a surgical declaration of anorchia

Background: In patients with impalpable testes, laparoscopy or open surgery is considered conclusive in establishing the absence of testicular tissue. Methods: Retrospective chart review. Results: Over a 22-year period, 4 out of 82 patients with a diagnosis of bilateral anorchia by laparoscopy or laparotomy had persistent testicular tissue suggested by endocrine evaluations. The clue to the presence of testicular tissue was: ( 1) a pubertal rise in plasma testosterone ( 2 patients); ( 2) the presence of possible Mullerian structures and of a detectable plasma anti-Mullerian hormone ( 1 patient), and ( 3) the fact that one of the gonads had not been seen at surgery ( 1 patient who still had a testosterone response to hCG postoperatively). Testes were localized by venography ( 3 patients) and laparotomy ( 1 patient). Conclusion: A surgical diagnosis of bilateral anorchia needs to be confirmed by hCG stimulation, gonadotropin levels, or other markers of testicular function. Copyright (C) 2004 S. Karger AG, Basel.