Undescended testis

2. 1. Undescended Testis: Along the normal path, but not
reached scrotum.
2. Retractile Testis: Hyperreflexic Cremaster
3. Ectopic Testis: Deviation from normal path of descent

3.  Genital ridge – intermediate plate mesoderm
 Germ cells derived from yolk sac.
 Leydig and Sertoli cells from mesenchyme
underlying genital ridge.
 Vas deferens formed by mesonephric duct

4.  Starts at 8th wk
 Reaches deep Inguinal ring by 3rd month
 Lies dormant upto 6th month
 Traverses Inguinal canal during 7th month
 Reaches Superficial ring by 8th month
 Reaches bottom of scrotum by 9th month
Why descend ?

5.  Trans abdominal phase – mainly mechanical
Increasing abdominal pressure
Differential growth of body wall
Pull by Gubernaculum
 Trans Inguinal phase – Combination of hormonal
and mechanical factors.
Testosterone – through CGRP
Processus Vaginalis

7. Absence of testis in scrotum since birth
Hemiscrotum empty, hypoplastic
Testis may or may not be palpable along the path of
descent.
70% of UDT are palpable, 30% non palpable.

9. Alteration of testicular structure
Leydigs cells
Germ cells
Infertility
Inguinal Hernia
Torsion testis
Malignancy
Trauma
Psychological

10.  If palpable- no investigations needed
 Unilateral impalpable- no investigations needed,
but USG is done by many
 Bilateral impalpable- rule out Intersex if genitalia
look abnormal.

11.  No surgical intervention till child is 1yr of age
unless there is associated complication like
hernia or torsion.
 Surgery if testis has not descended by 1 yr.

12.  Unilateral - Orchidopexy
 Bilateral – Orchidopexy in the same sitting.

13.  30% of all UDT
 45% are intra abdominal
 20% canalicular
 35% vanishing testis
 < 1% anorchia

14.  Blind ending vessels – terminate procedure
 Vessels exiting internal ring – Inguinal
exploration – orchidopexy / orchiectomy
 Intra abdominal testis – Fowler Stephen
procedure

15.  Look for testis / nubbin in the inguinal canal or
blind ending vas & vessels
 If canal is empty, open the deep ring and explore
retro peritoneum up to lower pole of kidney

16.  Groin incision
 Divide gubernaculum
 Herniotomy
 Divide bands holding the vessels to lateral abd
wall
 Place the testis in extra dartos pouch

20.  Communication exists between testicular artery
& artery to vas through small arterioles in the
peritoneal fold between them.
 If the testicular artery is ligated and this
peritoneal fold kept intact, testis can get
adequate blood supply from these collaterals.