SN7
SHORT NOTE
5M
Define Undescended Testis. Describe its types, clinical features, complications and management.
Definition
- Cryptorchidism (undescended testis) is the failure of one or both testes to descend into the scrotum.
- It is common in preterm infants and is one of the commonest genitourinary anomalies in boys.
Types
- True undescended — arrested along the normal path of descent (intra-abdominal, inguinal).
- Ectopic — outside the normal path.
- Retractile — a normal testis pulled up by an active cremasteric reflex (not truly undescended).
- Ascending — a previously descended testis that later rises.
Clinical Features
- An empty scrotum with a non-palpable or inguinal testis on examination.
- May be associated with an inguinal hernia.
Complications
- Infertility (impaired spermatogenesis, worse if bilateral).
- Increased risk of testicular malignancy.
- Torsion, trauma, associated hernia, and psychological effects.
Management
- Many testes descend spontaneously by 6 months of age — observe until then.
- Orchidopexy (surgical placement and fixation in the scrotum) is done between 6 and 18 months if it remains undescended.
- Early surgery reduces (though does not eliminate) the risks and allows monitoring of the testis.
Retractile VS True Undescended
A retractile testis can be gently coaxed into the scrotum and stays there briefly — it is a normal variant needing only observation, and must be distinguished from a truly undescended testis, which cannot be brought down.
WHY Timing Matters
- Early orchidopexy (by 12–18 months) helps preserve fertility potential and places the testis where it can be examined.
- Surgery reduces but does not abolish the increased malignancy risk — so self-examination is advised later in life.
Examination Tip
Examine the child warm and relaxed (a cold room triggers the cremasteric reflex and mimics undescended testis); if the testis can be milked into the scrotum and stays, it is retractile and needs only observation.
Orchidopexy reduces but does not eliminate malignancy risk.
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