Undescended Testis : Why? What to do?

by Dr. Patrick Balquet


he undescended testis is a term we use to describe all instances in which the testis cannot be manually manipulated into the scrotum.

The testes form from the medial portion of the urogenital ridge extending from the diaphragm into the pelvis. In arrested descent, they may be found from the kidneys to the internal inguinal ring.

Rapid descent through the internal inguinal ring commences during the pregnancy at approximately week 28, the left testis preceding the right.
Adequate amounts of male hormones are necessary for descent. The highest levels of male hormones in the maternal circulation have been demonstrated at week 28.

Thus, it appears that failure of descent may be related to inadequate male hormone levels or to failure of the end-organ to respond.
A patent processus vaginalis (small channel between the abdominal cavity and the scrotum) or a true hernial sac (the channel is then larger allowing sometimes a loop of small bowel to get out) will be present 90% of the time.

The normal situation is to have at birth both testicules descended in the scrotum. It is not true to think that they may later descend "by themselves"

The undescended testis found in 0.28% of males can be :

To improve spermatogenesis (producing an adequate
number of spermatozoids) surgery should be done before the age of two.

Electron microscopy has confirmed an arrest in spermatogenesis
(reduced number of spermatogonias and tubular diameter) in
undescended testis after the first two years of life.

Other reasons to pex are: a malignancy, trauma and torsion, and future cosmetic and psychological problems in the child.

The management is surgical; hormonal (Human Chorionic Gonadotropin) treatment has brought conflicting results except in some bilateral cases.

Surgery is limited by the length of the testicular artery.
Palpable testes have a better prognosis than non-palpable.
Parents should know the objectives, indications and limitations of an orchiopexy:

Laparoscopic exploration of the abdomen is more and more used for
Non palpable testicules.
These procedures are generally painless and very simple,full recovery
Is reached after 48 hours.

Conclusion : both testis must be found in the scrotum at birth.
If not,an assessment with the pediatric surgeon is needed,surgery
If indicated must be performed before the age of two.