Surgical Findings in Acquired Undescended Testis: an Explanation for Pubertal Descent or Non-descent?

Abstract

Aim:

Surgical findings were studied to find an explanation for the phenomenon that some acquired undescended testes (UDT) descend spontaneously whereas others need orchiopexy.

Methods:

In patients with acquired UDT spontaneous descent was awaited until at least Tanner stage P2G2. Orchiopexy was performed when a stable scrotal position had not been achieved by the end of follow-up.

Results:

Orchiopexy was needed in 57 of 132 cases (43%). In cases requiring orchiopexy, the difference in testis volume compared to the contralateral healthy testis was significantly larger than for spontaneously descended testes. 41 (72%) undescended testes were found in the superficial inguinal pouch; 16 (28%) at the external annulus. 26 of the 41 testes in the superficial inguinal pouch position (63%) could be manipulated preoperatively into a non-stable scrotal position; 15 could only reach the scrotal entrance prior to surgery. None of the 16 testes located at the external annulus could reach a scrotal position. Inguinal exploration in most cases revealed a fibrous string or a partially open processus vaginalis.

Conclusion:

The mobility of acquired UDT located within the external annulus is limited. It is mainly the fibrous string and the partially open processus vaginalis that prevent normal elongation of the spermatic cord with growth. These testes are unlikely to descend spontaneously. Acquired UDT lying in the superficial inguinal pouch can often be pushed down well below the scrotal entrance. We speculate that under normal hormonal stimulation at puberty, some of these growing testes may overcome the strength of the fibrous string in the spermatic cord and descend again spontaneously.

Key words

undescended testis - orchiopexy - abnormalities - surgical findings

• References

• 1 Bonney T, Hutson J, Southwell B et al. Update on congenital versus acquired undescended testes: incidence, diagnosis and management. ANZ J Surg 2008; 78 (11) 1010-1013
• 2 Tanyel FC. Obliteration of processus vaginalis: aberrations in the regulatory mechanism result in an inguinal hernia, hydrocele or undescended testis. Turk J Pediatr 2004; (46 Suppl) 18-27
• 3 Hack WW, van der Voort-Doedens LM, Goede J et al. Natural history and long-term testicular growth of acquired undescended testis after spontaneous descent or pubertal orchidopexy. BJU Int 2010; 106 (07) 1052-1059
• 4 Taghizadeh AK, Thomas DF. Ascent of the testis revisited: fact not fiction. BJU Int 2008; 102 (06) 676-678
• 5 Eijsbouts SW, de Muinck Keizer-Schrama SM, Hazebroek FW. Further evidence for spontaneous descent of acquired undescended testes. J Urol 2007; 178 (4 Pt 2) 1726-1729
• 6 Marshall WA, Tanner JM. Variations in the pattern of pubertal changes in boys. Arch Dis Child 1970; 45 (239) 13-23
• 7 Prader A. Testicular size: assessment and clinical importance. Triangle 1966; 7 (06) 240-243
• 8 Ritzen EM, Bergh A, Bjerknes R et al. Nordic consensus on treatment of undescended testes. Acta Paediatr 2007; 96 (05) 638-643
• 9 Sijstermans K, Hack WW, van der Voort-Doedens LM et al. Puberty stage and spontaneous descent of acquired undescended testis: implications for therapy?. Int J Androl 2006; 29 (06) 597-602
• 10 Atwell JD. Ascent of the testis: fact or fiction. Br J Urol 1985; 57 (04) 474-477
• 11 Clarnette TD, Hutson JM. Is the ascending testis actually ‘stationary’? Normal elongation of the spermatic cord is prevented by a fibrous remnant of the processus vaginalis. Pediatr Surg Int 1997; 12 (2/3) 155-157
• 12 Meij-de Vries A, Hack WW, Heij HA et al. Perioperative surgical findings in congenital and acquired undescended testis. J Pediatr Surg 2010; 45 (09) 1874-1881
• 13 Rusnack SL, Wu HY, Huff DS et al. The ascending testis and the testis undescended since birth share the same histopathology. J Urol 2002; 168 (06) 2590-2591
• 14 Elder JS. Epididymal anomalies associated with hydrocele/hernia and cryptorchidism: implications regarding testicular descent. J Urol 1992; 148 (2 Pt 2) 624-626
• 15 Turek PJ, Ewalt DH, Snyder 3rd HM et al. Normal epididymal anatomy in boys. J Urol 1994; 151 (03) 726-727
• 16 Han CH, Kang SH. Epididymal anomalies associated with patent processus vaginalis in hydrocele and cryptorchidism. J Korean Med Sci 2002; 17 (05) 660-662
• 17 Guven A, Kogan BA. Undescended testis in older boys: further evidence that ascending testes are common. J Pediatr Surg 2008; 43 (09) 1700-1704
• 18 Browne D. Diagnosis of undescended testicle. Br Med J 1938; 2 (4046) 168-171
• 19 Berkowitz GS, Lapinski RH, Dolgin SE et al. Prevalence and natural history of cryptorchidism. Pediatrics 1993; 92 (01) 44-49