Mar 27, 2008

Undescended Testis

Undescended testis means absence of one or both of the testes into the scrotum since birth. A doctor will detect it immediately after birth during complete examination of child or the parents usually notice this while bathing the child. There may or may not be a history of reducible swelling in the inguino-scrotal region indicating associated hernia. Apart from this, there are no other complaints.

On examination, the scrotum feels empty & undeveloped. The testis can be felt in the groin as a nodular structure slipping beneath the hand while doing gentle palpation in different positions like lying down or squatting position. This is called palpable testis. Some cases, the testis is not palpable in groin but can be found in other ectopic sites like perineum, root of the penis, medial side of the thigh or other side of the scrotum. These are called ectopic testis. In some cases, the testis is not palpable anywhere from groin to ectopic sites, then it may be in the abdomen on his descended route. This is called non-palpable testis.

The palpable testis are directly subjected for orchiopexy i.e. fixation of testis into the scrotum after mobilizing length of the cord through a groin incision. The non-palpable testis are subjected to further investigation to find out whether it is present or absent, exact position & size. Though ultrasonography, CAT scan or MRI imagings are done to look for this testis, the best investigation is diagnostic laparoscopy.

During the laparoscopy, one can trace the testis & at the same time bring back the testis into scrotum after mobilization. This can be done in one stage if the testis is not far away from the groin or in two stages if the testis is far away up into the abdomen.