Cryptorchidism, Empty Scrotum Undescended Testis | |
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Incidence | |
Undescended testis is a frequent anomaly. | |
Clinical significance | |
1. Impairment of the fertility. | |
Etiology | |
Unknown. | |
Pathology, anatomical types | Illustrations |
Testicular retention with arrest in the line of normal descent: Intraabdominal, canalicular and high scrotal testis (near the neck of the scrotum). | show details |
Pathophysiology | Illustration |
In undescended testis an increasing loss of spermatogones may be observed as early as in the first year of life, and again prior to puberty. It is not known if this cell death is a combined anomaly of undescended testis, or if it is a sequel of the high position of the testicle. | show details |
Clinical presentation (history, findings, clinical skills) | Illustrations |
History: The parents observe during personal hygiene of their children a permanently or occasionally empty scrotum. | show details |
Natural history | |
Beyond the age of one year, a descent does not occur any more. On the other hand, in (late) ascending testis the position is normal at the end of the first year, but becomes high following growth. This course may be observed in some children with cerebral palsy, or in some cases of retractile testis. In adults with undescended testis (with or without pre-existing surgery) a carcinoma in situ or a malignancy may be observed. | |
Differential diagnosis | Illustrations |
The differential diagnosis includes: | show details |
Work-up examinations | Illustrations |
In case of unilaterally or bilaterally non-palpable testis, ultrasound and clinical examination in general anesthesia may be performed, and, following these examinations in case of bilateral undescended testis, endocrinological examinations, and a diagnostic laparoscopy. | show details |
Therapy | Illustrations |
For the indication of treatment (hormone versus surgical treatment) it is important to know that the type of undescended testis can often be recognized only during surgery. Surgery is indicated in every case of non-palpable testis, of ectopic testis, and of undescended testis combined with an inguinal hernia. | show details |
Prognosis | |
Fatherhood in unilateral or bilateral undescended testis with palpable testicle is observed in more than 80 %, or in up to 60 %, respectively. However, there is no paternity in non-palpable bilateral testis.
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