Undescended testis: evaluation by magnetic resonance imaging.

We describe our experience of prospective magnetic resonance imaging (MRI) study in patients of undescended testis, with a 1.5 T equipment using body coil. There were thirty two patients, aged 1.5 to 14 years with a mean age of nine years. Surgical follow up was obtained for thirty one patients. We were able to indicate the position of 26 testes in 22 patients and absence of five testes in three patients. MRI was falsely positive and negative for five and two testes, respectively. Testicular tissue at ectopic site was identified by presence of characteristic signal intensity pattern, mediastinum testis and its location along empty spermatic canal in cases of inguinal testis either singly or in combination. MRI was able to detect atrophic changes in four testes, confirmed on surgery. The study concludes that MR imaging is useful in the localization and tissue characterization of a non palpable testis. However, it is not sensitive enough for complete exclusion of the diagnosis of an undescended testis. Thus a surgical or laproscopic exploration may be needed further in selective cases for the management of patient.     

Undescended testes

Undescended testis or cryptorchidism is a common problem encountered in children. Despite the abundant literature on the pathology and management of undescended testis, it is the subject of numerous misgivings and controversies. The article reviews available literature on the entity and their relevance in clinical practice.     

未触及隐睾的临床处理

目的：探讨未触及隐睾的临床处理。方法：未触及隐睾２２例２６例均行于ｈＣＧ治疗，２６例均行手术探查。结果：ｈＣＧ治疗后有３例单侧于腹股沟区可触发睾丸，１例双侧ｈＣＧ激发发试验阴性，２例单侧无睾丸，１便双侧睾丸发育不良。１７例睾丸固定于阴囊底肉膜外，５侧分期手术，随访１７例２－１１年，其中回缩２侧，萎缩１例，结论：未触及隐睾尚无一简便明确的方法可证实睾丸的存在，ｈＣＧ激发试验回判断双核隐睾患儿有无睾丸     

Undescended testes: Treatment with gonadotropin

The therapeutic success of treatment of testicular maldescent must be judged according to 2 parameters,-I. occurrence of descent, II. fertility. Ad I. Indication for hCG-treatment is always given unless an unequivocal indication for operation exists, i.e. ectopias, accompanying hernias, retention after herniotomy and advanced puberty. The optimal time for treatment is the second year of life. The large European statistics which include the prescrotal but not the retractile testes, unanimously show success rates of 50–55%. In the largest American series which does not include prescrotal testicles, descent was observed in 40% of the bilateral and in 30% of the unilateral cases. Analyzing those cases which did not respond to hormones but had to be operated, in the majority of cases ectopic, not dystopic gonads were found. Ad II. Infertility in testicular maldescent can have two reasons, 1. congenital anomalies of the primordium, 2. acquired damages due to the malposition. The few large prospective studies at hand show fertility in the majority of cases with descent after hCG, but in the minority of those coming down only after additional operation. Obviously the latter group represents a negative selection. Unilateral cases had a higher fertility rate than bilateral ones.     

Undescended testicles: an epidemiological review

In a retrospective study the records of 447 boys (median age 5 y, age range 2 wk to 12 y) undergoing orchidopexy in a university hospital paediatric surgical department over a 2-y period were analysed for epidemiological factors related to disturbed testicular descent by comparison with the notes of an equal number of otherwise healthy male trauma patients matched for age. There were higher rates of peripartal asphyxia and intrauterine growth retardation (reflected by lower birthweights in combination with equal gestational age distribution), more complicated deliveries, an increased incidence of congenital malformations and more frequent occurrence of a number of chronic diseases in the families of affected boys. First- and second-born boys were over-represented in the study group. A cyclical pattern for the month of birth is suggested by the data, but this did not reach statistical significance. Neither was any statistical difference found for premature delivery, the incidence of extra-uterine fertilization, hormonal treatment of the mother while pregnant, twin pregnancies, threatened or imminent abortions or parental age. The literature dealing with this topic was reviewed. Discrepancies between different studies can be explained, at least in part, by considering different forms of undescended testicles as different nosological entities that should be assessed separately in forthcoming research.     

Undescended testes: early versus late maldescent

A review of 468 orchidopexies was undertaken to ascertain the importance of a complete hernial sac extending to or beyond the testis. A hernial sac was present in 84% (171/202) of testes in patients under 5 years of age, in contrast to 23% (61/266) in patients over 5 years. It seems reasonable to presume that the failure of the hernial sac to close is secondary to failure of normal descent, which in turn is due to antenatal factors and may be classified as early maldescent. In the older age group maldescent is due to failure of the last stage of descent, which should occur in the 5- to 10-year prepubertal age period (late maldescent, or the ascending testis). The cause of late maldescent is not due to a short processus, as this increases in length with age (approximately 0.5 cm/year), unless the persistence of the processus itself is the cause. A classification of early or late maldescent is suggested.     

Undescended thymus presenting as midline neck swelling

A seven month male child presented with midline neck swelling which was visible in the suprasternal notch when the child cried. Computed tomography revealed that it was thymic tissue (solid). There was no thymic tissue in the normal position. Undesended thymus or ectopic thymus is a rare cause of neck mass. Solid type as seen in this case constitute 10% of ectopic thymic tissue ,90% being of cystic variety. Caution should be exercised in excision of such masses as they may be the only thymic tissue.     

Undescended Testis: Congenital or Acquired?

There is considerable evidence to indicate that in some cases undescended testis has a familial incidence, as shown by two family histories. Carefully documented family histories, commencing with routine examinations at birth and at the 6 week 'check up' can provide evidence that an undescended testis may be an acquired condition and is not necessarily congenital.     

Fetus in Fetu Associated with an Undescended Testis

Fetus infetu is an extremely uncommon cause of an abdominal mass in the neonate; fewer than 30 generally accepted cases are recorded in the literature. We report a case of intraabdominal fetus infetu, with a unique location within an undescended left testicle. Chromosomal studies of cells from the fetus infetu and the surviving infant revealed identical 46, XY karyotypes.