Maldescended testis


Definition

Incomplete descent of testis to scrotum

Cryptorchidism

· in-line of normal descent

Ectopic

· outside line of normal descent

Epidemiology

· 3% of full term boys

· If not down by 1yr, unlikely

· 15% FHx

Location

Cryptorchid

· High scrotal / superficial inguinal ring 70%

· Inguinal 20%

· Intra-abdominal 10%

Ectopic

· Superficial to external oblique

· Perineal

· Femoral D

· Root of penis

· Pelvic

Complications

· ¯ fertility

— If unilateral orchidopexy, 30% still have ¯ sperm count

— Bilateral

40% no sperm

30% reduced

· Testicular Ca

— RR 20x

— Abdominal testis ­ risk

— Orchidopexy < 6yrs protection conferred

— Post pubertal orchidopexy – no protection

· Hernia ³25%

· Torsion 2%

Ix

· For impalpable testes

USS

? CT

? Testicular venography

Laparoscopy

Inguinal exploration

Rx

· Scrotal approach orchidopexy

— <6 yrs / ASAP

— Lengthen cord

Skeletonise

Take down lateral bands

— Dartos pouch