An un-descended testis is one which has failed to descend to the scrotum and is retained at any point along the normal path of its descent. Un-descended testis is more common on the right side (observed in 50% cases). It is less common on the left side (found in 30% cases). About 20% cases are bilateral. When both the testes are absent in the scrotum, the condition is called as cryptorchidism (hidden testes).
Types Of Un-Descended Testis
- Lumbar testis- complete failure of descent and the testis remains whence it was developed.
- Iliac testis- testis remains just deep to the deep inguinal ring.
- Inguinal testis- testis is found in inguinal canal.
- At the superficial inguinal ring- the testis frequently comes to rest just outside the external inguinal ring.
- Scrotal testis- testis lies in the upper part of the scrotum.
Symptoms Of Cryptorchidism
Un-descended testes are usually noticed in children, but do not come under notice until adolescence or sometimes even adulthood.
Absence of one or both testes from the scrotum is the most common symptom of Cryptorchidism. Children or parents first notice that the scrotum is not developed, rather than absence of testis within it. Occasionally person in adult life realizes the same with infertility.
A small percentage of cases suffer from indirect inguinal hernia i.e. swelling the groin, along with un-descended testis.
Complications Of Incomplete Descent Of Testis
- Torsion of testis.
- Epididymo-orchitis (testicular inflammation).
- Indirect hernia or interstitial hernia (found in 80% of cases).
- Atrophy of incompletely descended testis.
- Pain due to trauma is common in testis situated in inguinal canal.
- Sterility and malignancy.
Treatment Options For Cryptorchidism
Hormonal therapy of Cryptorchidism: This should not be used as a routine treatment for incompletely descended testis.
The hormone therapy of Cryptorchidism mostly used is the Chorionic gonadotrophin in doses of 5000 i.u.
Surgical treatment of Cryptorchidism
- Orchidopexy- It is the treatment of choice. Definite histologic changes can be demonstrated in an incompletely descended testis by the age of 6 years. The placement of testis in the scrotum (orchidopexy) should be accomplished by the age of 5 years.
- Orchidectomy (removal of testis) – This form of surgery is advocated only when the opposite testis is normal and when incompletely descended testis cannot be brought down.
- Orchidoceplioplasty- This method involves the abdominal replacement of testis. It is indicated when the other testis has been removed previously and this testis cannot be brought down to the scrotum. Therefore, it preserves internal secretion of the testis and protects the testis from trauma.