- Cryptorchidism is testis that isn’t within the scrotum and doesn’t descend spontaneously into the scrotum by four months of age.
- Undescended testis happens when the testis stops short along their normal path of descent into the scrotum.
- Ectopic testis occurs when testis that doesn’t follow their normal descent path; is diverted into an aberrant position.
Theories to the descent of testes;
- Hormonal theory- the presence of testosterone is essential
- Gubernaculum theory- it has to attach to the scrotum and pull the testis down
- Increased abdominal pressure- necessary for descent
- Differential body growth- organs move downward and the body upwards with growth
Risk factors
- Prematurity
- Small for gestational age neonates
- Genetics and environmental factors
- Birth weight <2.5kg
- Prenatal exposure to disrupting chemicals
Associated conditions
- Abdominal wall defects
- Neural tube defects
- Cerebral palsy
- Disorders of sexual development
Clinical features
- Empty or poorly ruggated scrotum
- Inguinal fullness
- Location- mainly outside the external ring. Others are the inguinal canal and abdomen
- 10% are bilateral
Complications
- Inguinal hernia
- Testicular torsion, testicular trauma
- Subfertility
- Malignancy- in 10%
Management
Timing- Before the age of 2 (preferably one year)
- Palpable testis- orchidopexy. The role is to bring it down and also for early cancer detection. Doesn’t prevent cancer
- Non-palpable testis- imaging and explorative surgery
- Repair of inguinal hernia if present
