Previous testicular position in boys referred for an undescended testis: further explanation of the late orchidopexy enigma?

Abstract

RESULTSOn referral, 340 testes were not in the scrotum (182 uni-and 79 bilateral). Of the 340 testes, 82 (24%) in 61 boys were diagnosed as retractile, whereas the remaining 258 in 221 boys were undescended. The previous testicular position was known in 208 of 221 boys (94%), with 244 UDTs. In 65 of these 244 (26.6%) the testis had never been scrotal (congenital UDT); in 179 (73.4%) a previous intrascrotal position was recorded in early childhood (acquired UDT) at least once, in 149 (61%) at least twice and in 117 (48%) at least three times. The mean age at referral for congenital UDT was 2.1 years and for acquired UDT was 8.4 years. CONCLUSIONSThese results show that acquired UDT is frequent, and occurs at about three times the rate of congenital UDT. Because these boys are referred for treatment later in childhood, the acquired UDT probably accounts for the high rate of (late) orchidopexy.

Practice variation and clinical confusion regarding undescended testes and retractile testes among primary care respondents: a multi-regional survey study in the United States

“…The elevated risk of cancer in these testes requires regular exams which are facilitated by orchidopexy which places the testes in the normal anatomic position. In contrast to UDT, secondary testicular ascent of retractile testes has been described as common in some referral populations [2,10,11], and it typically requires only yearly exams by a primary care provider to ensure proper ultimate position within the scrotum. This secondary process may lead to a bimodal referral pattern of patients with undescended testes, infants and those greater than 2 years of age.…”

Acquired Cryptorchidism: What Should We Know? The Results of a Systematic Review

“…A UDT was defined as a non-palpable testis inside the scrotum and for which further traction on cord traction was painful (Meij-de Vries A et al 2010). A congenital UDT was defined as a testis which had not previously descended (Meij-de Vries A et al 2010, Hack WW et al 2003b), whereas an acquired UDT was defined as an UDT in which a previous scrotal position was documented on at least one occasion (Barthold JS & González R 2003). This does not include testes identified as being cryptorchid after inguinal surgery.…”

“…Clarnette et al (Clarnette et al 1977, Clarnette et al 1997 reported the presence of a fibrous structure extending with the cord structures, which on immunohistochemistry showed the characteristics of a remnant of the PV. Other studies found the presence of PV or hernia sac in 23%-76% of orchiopexies for acquired UDT (Robertson JF & Azmy AF 1988, Wright JE 1989, Meijer RW 2004, Gracia J et al 1997, Eardley I et al 1994, Hack WW 2003b. Based on these findings, it was suggested that the persistence of a patent PV or its remnants is responsible for tethering the testis in a static position during a period of somatic growth.…”

“…In a study from Oxford (John Radcliffe Hospital Cryptorchidism Study Group 1986)) was found that 40% of boys whose testicles had not descent at birth but had done so by 3 months became undescended by the age of 1 year. Since then, others have given various rates, with ascending testes comprise 16% (Fenton EJM et al 1990), 2.3% (Gracia J et al 1997), 5% (Eardley I et al 1994), 20% (Rabinowitz R & Hulbert WC, Jr 1997 ), and 73% (Hack WW et al 2003b) of all orcidopexies. In a cross sectional Dutch study, Hack et al (Hack et al 2007a) found a prevalence of acquired UDT up to 2.2% among 6-13 year old boys.…”

“…Most authors agree that acquired UDTs is a common phenomenon outnumbering congenitalUDTs by a factor of two to three (Hack WW et al 2003b, Hack WW et al 2007a 1, Agarwal PK et al 2006. This could mean that the pathogenesis of AUDTs, as in congenital forms, is multifactorial also.…”