Undescended Testes

UNDESCENDED TESTES

• Incidence: In premature infants: 30%; In full term infants: 4%; At 3 months- 2%
• Testis absent from scrotum after 3 months of age are unlikely to descent fully
• Incompletely descended testis tends to atrophy as puberty approaches
• More common on the right side(50%) and 20% cases are bilateral (cryptorchidism)
• Secondary sexual characters are normal 

Etiology

• Gubernacular dysfunction
• Lack of gonadotropins [HCG]
• Lack of CGRP –calcitonin gene related peptide
• Prune Belly syndrome
• Familial 

Complications

• Torsion
• Epididymo-orchitis(may mimic appendicitis)
• Sterility (in bilateral cases, especially- intraabdominal testis)
• Indirect Inguinal hernia
• Increased liability to malignant disease
• Atrophy 

Treatment

• Orchidopexy is usually done before 6 months of age
• Orchidectomy: if the incompletely descended testis is atrophic, if patient is past puberty & other testis is normal
• In bilateral cases, testis is passed into the opposite scrotum through an opening in the scrotal septum – Ombredanne’s operation
• HCG or GnRH can be given when cryptorchidism is associated with hypogenitalism and obesity