Decreased Incidence of Appendix Testis in Cryptorchidism with Intraoperative Survey

Abstract

Objective: Several authors have investigated the background of the process of testicular descent, but the role of the appendix testis has not been studied. The human appendix testis was found to express both estrogen and androgen receptors. We determined and compared the occurrence of testicular appendices intraoperatively in descended and undescended testes. Methods: The number of appendix testis was evaluated retrospectively in 208 boys who underwent uni- or bilateral orchiopexy, hydrocele or hernia repair and the testis was visible during operation. Results: The incidence of appendix testis was 76% (78 in 103) in descended and 24% (30 in 125) in undescended testes. Mean age at orchiopexy was lower in patients without appendix testis (39 months) compared to those patients who were found with appendix (61 months). Conclusion: The incidence of appendix testis was significantly lower (p < 0.05) in undescended testes, suggesting that the appendix testis might play a role in the process of testicular descent.

The Role of the Appendix Testis in Normal Testicular Descent: Is There a Connection?

“…The reason for this finding could be explained by the role of the AT in the descent of the testes, either fully or partially which is in accordance with the results of Józsa et al who concluded that finding of reduced incidence of TAs in UDTs may indicate that AT potentially has an important role in the testicular migration process [ 7 ]. Further investigations that focused on the anatomical and functional characteristics of AT during fetal life could offer a clearer understanding of the real role of AT in the process of normal testicular descent.…”

“…In order to clarify the process of testicular descent, numerous studies hypothesized about the possible role of AT in normal testicular descent [ 6 , 7 , 23 ]. The role of androgen hormones in the inguinoscrotal phase of the process of testicular descent is well known [ 24 ], particularly through mediation in the regression of the cranial suspensory ligament [ 25 ].…”

“…In contrast to our results, Tostes et al did not find a significant difference in the number of testicular appendices in UDTs in relation to the testicular position in the patients with undescended testes [ 23 ]. However, there are studies that have noted significantly decreased incidence of ATs in UDTs compared with descended testes [ 6 , 7 , 27 ].…”

“…However, many aspects of impairment of testicular descent are still unclear. In an attempt to clarify these uncertainties, recent studies have hypothesized about the possible role of the appendix testis (AT) in testicular descent noticing a reduced incidence of AT among boys with undescended testes (UDTs) compared to boys without testicular maldescent [ 6 , 7 ]. According to the best of the author's knowledge, there is no report of the conducted studies that have compared the incidence of AT in congenital UDTs at different localizations.…”