Storm D et al. (2007) Histologic evaluation of the testicular remnant associated with the vanishing testes syndrome: is surgical management necessary? Urology 70: 1204–1206

The role of exploratory surgery in the management of patients with congenital anorchia ('vanishing testes syndrome') remains controversial because of uncertainty over the prevalence of viable germ-cell elements within testicular remnants.

Storm and colleagues retrospectively reviewed the records of 56 patients with congenital anorchia who underwent laparoscopic removal of testicular remnants at one of two US centers during 1994–2006. Mean patient age was 44.5 months (range 11–216 months). All remnants were successfully removed, although one patient developed a scrotal hematoma that resolved with conservative management.

Histological analysis revealed viable germ-cell elements in 8 (14%) of the testicular remnants; seminiferous tubules without germ-cell elements were identified in a further 4 (7%) specimens. The mean ages of patients whose testicular remnants contained viable germ-cell elements and seminiferous tubules without germ-cell elements were 16.5 months and 28 months, respectively. What the fate of these elements would be if testicular remnants were left in situ is not known; the authors suggest that these tissues could potentially undergo malignant transformation. Storm and colleagues consequently advocate surgical excision of testicular remnants, and suggest that their laparoscopic removal is an effective and minimally invasive approach to management of patients with congenital anorchia.