ABSTRACT
UNDESCENDED TESTES (CRYPTORCHIDISM) ■ Testes descend through the inguinal canal to the scrotum in the third trimester of pregnancy ■ Approximately 3.5% of boys have undescended testes at birth and 1.5% at 3 months of age (as some
descend after birth) ■ After 9 months of age they rarely descend spontaneously ■ Undescended testes have an increased rate of malignant transformation even after orchidopexy ■ They may be: – Bilateral or unilateral – Palpable or impalpable – Somewhere along the normal line of descent or ectopic ■ Not to be confused with
retractile testes, which can be massaged fully into the scrotum with no tension but retract back into the inguinal canal
■ To examine the testis, it is massaged gradually down the inguinal canal into the scrotum if possible
■ Karyotyping should be done if bilateral impalpable testes or bilateral/unilateral impalpable testes are associated with abnormal genitalia
■ Check b-hCG if bilaterally impalpable
Investigations and management Palpable Inguinal orchidopexy Impalpable Laparoscopy to make the diagnosis and then proceed according to findings Present – orchidopexy (usually in two stages laparoscopically 3 months apart)
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Dysplastic – excision laparoscopically and fi x remaining testis (as for absent testis) Absent – fi x remaining contralateral testis in the scrotum to avoid the small risk of
torsion
Orchidopexy (surgical correction) This is usually done before the age of 2 years as a one-or a two-staged procedure, depending on the length of the testicular artery. It is done for:
■ Cosmetic reasons ■ To optimize testicular development and theoretically to increase fertility ■ To allow early detection of malignant change
If the testis is abnormal or unilateral intra-abdominal and unable to be corrected, it is removed (orchidectomy).
