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
Absence of testis in scrotum since birth
Hemiscrotum empty, hypoplastic
2. Absence of Testes
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
Embryology
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 ?
Descent of Testes
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
Factors responsible
for the descent
6.
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.
Clinical Features
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.
Investigations
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.
Management
12. Unilateral - Orchidopexy
Bilateral – Orchidopexy
in the same sitting.
Palpable Testes
13. 30% of all UDT
45% are intra abdominal
20% canalicular
35% vanishing testis
< 1% anorchia
Impalpable Testes
14. Blind ending vessels – terminate
procedure
Vessels exiting internal ring -
Inguinal exploration – orchidopexy /
orchiectomy
Intra abdominal testis – Fowler
Stephen procedure
Laparascopy
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
Inguinal
Exploration
16. Groin incision
Divide gubernaculum
Herniotomy
Divide bands holding the vessels to
lateral abd wall
Place the testis in extra dartos pouch
Orchidopexy
17.
18.
19.
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.
Fowler Stephen
Procedure