Undescended testis is defined as the testis, which cannot be brought to the base of the scrotum without undue tension on the spermatic cord.

This anomaly is often diagnosed early but the treatment is delayed due to misconceptions leading to various complications.

Salient features

•           The testis can be located in the superficial inguinal pouch, inguinal canal or intra-abdominal site. Truly ectopic testis can be present in perineum, femoral region, pubopenile site or contralateral hemiscrotum.

•           Differentiate from retractile testis which is occasionally pulled up due to reflex contraction of cremasteric muscle. The retractile testis is normal in size, can be brought down into scrotum where it stays for some time and the scrotum is normally developed.

•           Complications of undescended testis include temperature effects on testis, endocrine effects, germ cell alteration, lower fertility; higher incidence of malignancy, increased incidence of torsion, increased chances of-trauma and psychological trauma.

Treatment

1.      If the newborn child is seen with unilateral undescended testis, follow up the patient at intervals to see the descent.

•           If testis fails to descend by the age of 12 months, orchiopexy is advised.

•           If seen after first birthday the operation of orchiopexy should be done before the age of two years.

•           The operation entails mobilizing the testis and cord structures and fixing it in the subdartos pouch in the scrotum with unabsorbable sutures.

2.      If the newborn child has bilateral undescended testes with hypospadias, it should be investigated for intersex disorder.

3.      If a child has undescended testis with clinically visible hernia, orchiopexy can be done at an earlier age along with herniotomy.

Patient education

The parents should be informed about the anomaly if detected at birth and advised to monitor the descent of testis and to get it operated by the age of 1 year.