Undescended Testis

What is the difference between undescended testis and retractile testis?

Undescended testis is a result of testis getting arrested in its path of descent which could be intraabdominal, inguinal or high scrotal. The retractile testis is a testis which has completed its descent and is a result of hyperactive cremasteric reflex and when manipulated it stays at the base of scrotum temporarily.

The best of differentiating clinically the retractile testis from undescended testis in older children’s is to make them sit in squatting position which relaxes the cremasteric reflex and brings retractile testis down.

Why documentation of testis in newborn period is important?

In newborns, cremasteric reflex is absent and absent testis in hemi-scrotum is a true undescended testis. So a documented undescended testis in newborn is always a true undescended testis.

Why treatment of undescended is testis is required?

In newborns, cremasteric reflex is absent and absent testis in hemi-scrotum is a true undescended testis. So a documented undescended testis in newborn is always a true undescended testis.

At what age undescended testis should be operated?

Spontaneous descent of testis is possible only till 3 to 6 months of gestational age. Histological examination of undescended testis has revealed a progressive loss of germ cells and Leydig cells. Hence it is recommended that surgery should be done between 6 months to one year of age.

What investigations are required for undescended testis?

A good clinical examination is required to locate the position of undescended testis. Imaging studies cannot determine with certainty whether a testis is absent or present. Ultrasound can help to locate the testis in inguinal area but not a good test for locating intraabdominal testis. MRI is a sensitive test to locate testis but not routinely recommended as is expensive, needs sedation for child and also does not change the course of management. The gold standard for locating the testis is diagnostic laparoscopy.

What is the management of undescended testis?

A testis which is palpable requires open orchidopexy. This also requires ligation of patent processus vaginalis.

A testis which is non- palpable can be intraabdominal or atrophic or sometimes difficult to palpable in a obese child. Laparoscopy is best answer for these testes as it is not only diagnostic as well as therapeutic. It can locate the testis and at the same time testis can be brought down to its normal position.