Paediatrics: Undescended testes (cryptorchidism)

Undescended testes (cryptorchidism)

The testes descend through the inguinal canals into the scrotum during the first trimester. Cryptorchidism (Fig. 23.20) is seen in 3% of full-term newborn boys and 1% of boys at 1yr. Spontaneous descent may occur in the first 6mths, but is unlikely after this. Cryptorchidism is more common in premature infants.

Clinical aspects

Undescended testes are subdivided into the following.

•   Palpable undescended testes (80%): usually at the external inguinal ring. These testes can be bought down into the scrotum with an orchidopexy performed through an inguinal incision.

•   Impalpable testes (20%): intra-abdominal, inside the inguinal canal, or absent. There is risk of malignant degeneration in an intraabdominal testis (1:70, compared with 1:5000 for normal testis). Laparoscopy is the investigation of choice for an impalpable testis. US, CT/MRI are not helpful. If the vas and vessels enter the deep inguinal ring (30%), an inguinal orchidopexy is indicated. If the vas and vessels end blindly at the deep ring (30%), then the testis has torted in utero and has resorbed. No further action is necessary. If a testis is seen inside the abdomen then it must be removed or bought down with a two-stage orchidopexy.

When should boys be referred to a surgeon?

•   If an undescended testis is noted on routine postnatal check, this should be documented in the medical records.

•   Initial follow-up should be with the GP because the majority of these testes will descend during the first 6mths of life.

If still undescended at 6mths, refer to a paediatric surgeon