الفهرس 
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Abstract
Cryptorchidism means failure of one or both testes to descend into the scrotum prenatally which occurs in 2.4–5 % of newborns. Cryptorchidism can affect fertility with increased risk for testicular malignancy if uncorrected.
Despite the recommendations for the treatment of the cryptorchid testis before 2 years of age, many of our patients were older, due to the socio-economic characteristics, the lack of parental information with late diagnosis.
So, we advise by early screening for undescended testes for early diagnosis and management to avoid the effect of late diagnosis on fertility.
With advancements in laparoscopic techniques and instrumentation, laparoscopic orcheopexy has become the treatment of choice for management of impalpable undescended testes.
Laparoscopic TTT (Shehata Technique) is a new Technique for treatment of high IAT. In this technique the lower pole of the testis is fixed above the contralateral anterior superior iliac spine. Laparoscopy is carried out after 3 months to check the new position of the testis and to locate the testis intra-scrotum. Shehata Technique is based on lengthening instead of dividing the testicular vessels thorough gradual traction by the weight of the intestine.
This study was carried out to evaluate both vascular and histological effect of laparoscopic two stage testicular traction by three ways 1. Chang of size of testis at 1st and 2nd stage measured by Ultrasound by measuring of three dimensions of testis during 1st and 2nd stage all data summarized and documented 2. Resistive index measured for each testis during 1st and 2nd stage by Ultra sound by radiologist over three points of testis and we considered reading more than 0.60 mean affection of parenchymal blood supply
With advancement of radiological tools, we consider RI is good indicator and directly related to affection of germ cell number and seminiferous tubules number in testicular biopsy and can used if testicular biopsy not preferred (refuse of care givers, very small size testis) as predictor of future fertility of testis.
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Testicular volume alone not sufficient for measurement or expectation of future fertility as many cases there were no significant changes of testicular size between both stages of laparoscopic traction but there were affection of germ cell no and seminiferous tubules.
Despite several attempts to find a surgical technique without any significant complications, all described procedures failed to meet the target. But still laparoscopic traction for high intra-abdominal testis is safer reliable and successful and preferred to techniques requiring vascular division, burden with higher incidence of atrophy.