To assess diagnostic accuracy, laparoscopy and surgical exploration were prospectively performed in 104 children with 126 nonpalpable testes. Laparoscopic localization of the testis was correct in 90% (114 of 126 testes) and was nondiagnostic in 8% largely due to preperitoneal insufflation. No surgical complications occurred. Using the criteria of blind-ending vas deferens and spermatic vessels as diagnostic of an intra-abdominal vanishing testis, the accuracy of diagnosis was 100% but the inability to identify either vas or vessels was associated with intra-abdominal testes in 2 of 3 cases. Identification of canalicular vas deferens and spermatic vessels was associated with testes in 36 of 75 cases (48%). Bilateral nonpalpable testes were significantly less likely to have an absent testes (5%) than a unilateral nonpalpable testis (59%), suggesting the possibility of different pathophysiological mechanisms in those entities. Diagnosis and surgical management of nonpalpable testes were directly impacted by laparoscopy in 42 of 117 testes (36%) by identifying intra-abdominal vanishing testis, the location of an intra-abdominal testes or the need for retroperitoneal exploration when vas deferens and spermatic vessels were not found. Accurate knowledge of testis location in 97% of the testes facilitated development of an appropriate surgical strategy (that is laparoscopic/laparoscopic assisted versus open procedure).