1. Undescended testis occurs when the testis follows the normal path of descent but fails to reach the scrotum. Retractile testis involves a hyperreflexic cremaster muscle. Ectopic testis deviates from the normal path of descent. 2. Testicular descent normally begins at 8 weeks in the abdomen and reaches the scrotum by 9 months. A combination of mechanical and hormonal factors drive descent through the abdominal and inguinal phases. 3. Undescended testis can cause alterations to testicular structure and function, leading to infertility, hernia, torsion and malignancy risks if uncorrected. Orchidopexy is the surgical treatment to

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.