SU30.2 | Undescended Testis — Summary & Reflection

KEY TAKEAWAYS

An undescended testis (cryptorchidism) is one whose descent has arrested along its normal path from the posterior abdominal wall through the inguinal canal to the scrotum; it is classified as palpable (canal/superficial ring) or impalpable (intra-abdominal or absent/atrophic). It must be distinguished from a retractile testis — a normal variant that coaxes into the scrotum and stays, needing only reassurance — and from an ectopic testis in an abnormal site after descent. The malpositioned testis sits at too high a temperature, causing impaired spermatogenesis/subfertility (worse if bilateral) and an increased risk of germ-cell malignancy that persists even after orchidopexy; a patent processus vaginalis often gives a coexisting indirect hernia. Examination (warm room/hands, frog-leg position, milking the canal) makes most of the diagnosis; ultrasound is unhelpful for the impalpable testis, for which diagnostic laparoscopy is the gold standard, with hormonal tests and karyotype for bilateral impalpable testes to exclude a disorder of sex development. Treatment is orchidopexy at about 6–18 months, with Fowler–Stephens orchidopexy or orchidectomy for high intra-abdominal, atrophic or post-pubertal testes, plus counselling on fertility, persisting cancer risk, and lifelong self-examination.

REFLECT

Picture the next baby check or paediatric clinic where you are asked to 'check the testes'. Are you confident you could examine in a warm room with warm hands, in the frog-leg position, and milk the canal to bring down a canalicular testis — and, crucially, decide whether what you feel is undescended, ectopic or merely retractile? Would you resist the temptation to order an ultrasound to 'find' an impalpable testis, knowing a negative scan cannot exclude one and that laparoscopy is the answer? And if you were counselling parents, could you explain calmly why surgery is timed for the first year or two of life, and why their son will still need to examine himself for life despite a successful operation? Reflect on how a careful examination and a clear conversation today shape a man's fertility and cancer surveillance decades later.