Undescended testis

Abstract

Cryptorchidism is a common surgical problem in neonates and infants. Evaluation of the undescended testis requires a good history and thorough physical examination. An undescended testis is usually associated with a concomitant inguinal hernia, is at increased risk of malignant degeneration, and is associated with abnormal spermatogenesis and decreased fertility. Medical treatment of cryptorchidism has a limited role. Surgical treatment depends on the age of the child and the location of the testis. A testis that is located distal to the external inguinal ring is best managed through an inguinoscrotal orchidopexy. If the testis is located more proximally, or is not palpable, laparoscopic exploration is performed. Intra-abdominal testes are best managed by a two-stage Fowler-Stephens orchidopexy: the testicular vessels are occluded to allow the testis to be pulled through on collateral vascularization. Regardless of the method used to bring the testis into the scrotum, it is typically placed in a subcutaneous pouch superficial to the dartos fascia through a separate scrotal incision.