Undescended testis refers to the obstruction of testicular descent, where the testis remains along the pathway of descent and fails to enter the scrotum. Clinically, it is commonly referred to as cryptorchidism. Cryptorchidism is a congenital condition. Its occurrence is associated with hormone levels, a short testicular ligament, and a short spermatic cord. Cryptorchidism often occurs unilaterally, with bilateral cases accounting for approximately 10-25%. It is frequently accompanied by an indirect inguinal hernia. Testes retained in the abdomen or inguinal region, where the temperature is higher than in the scrotum, suffer from developmental impairment and degeneration of the seminiferous tubules, leading to spermatogenic dysfunction. Over time, by adolescence or adulthood, cryptorchidism may also develop into testicular tumors. Therefore, early treatment is recommended to relocate the testis into the scrotum and avoid complications. This condition is classified into three types based on the location of the testis: intra-abdominal, inguinal canal, and external ring types.

bubble_chart Clinical Manifestations

1. Unilateral or bilateral scrotal atrophy, with no testis palpable within the scrotum.

2. A testis-like mass may be palpable in the inguinal region, or symptoms of an oblique hernia may be present.

3. If the undescended testis has undergone malignant transformation, a mass in the abdomen or inguinal region may sometimes be palpable.

4. In adults with bilateral cryptorchidism, sterility may occur.

﹝Auxiliary Examinations﹞

For undescended testes located in the inguinal region, physical examination can detect the testis, and no special localization tests are required. If necessary, a routine B-ultrasound or color Doppler ultrasound can be performed to assess its nature. However, for high abdominal cryptorchidism where the testis cannot be palpated manually, laparoscopy or spermatic vein angiography may be performed if conditions permit to determine its location and nature, facilitating surgical planning and localization. However, these examinations are invasive and should not be routinely applied.

1. The affected scrotum has no testis and is relatively small.

2. For patients with inguinal canal or external ring type, the testis can be palpated in the corresponding area, usually smaller. The intra-abdominal type cannot be palpated.

3. Incomplete testicular descent may be complicated by hydrocele or indirect inguinal hernia.

4. B-ultrasound, CT scan, and spermatic vein angiography are helpful for the diagnosis of intra-abdominal type patients.

bubble_chart Treatment Measures

Treatment Measures

1. Endocrine Therapy

Suitable for bilateral cases in children under 5 years old. Human chorionic gonadotropin (HCG) 500-1000 IU can be administered intramuscularly every 3 days, with a total dose of 15,000-20,000 IU. Luteinizing hormone-releasing hormone (LH-RH) may also be used.

2. If endocrine therapy is ineffective, orchiopexy should be performed. Intra-abdominal type cases should be operated at 2 years old, while inguinal canal and external ring types should be performed at 3 years old, no later than 5-6 years old. Unilateral cryptorchidism in adults and cases with malignant transformation should undergo orchiectomy.

3. For intra-abdominal and inguinal canal types, high retroperitoneal spermatic cord release and orchiopexy should be selected. External ring type cases can undergo orchiopexy via the inguinal approach.

4. For bilateral cryptorchidism patients, preoperative treatment with human chorionic gonadotropin (HCG) or gonadotropin-releasing hormone (LHRH) should be administered first to promote testicular descent.

Medication Principles

1. For cryptorchid children, whether unilateral or bilateral, LHRH nasal spray can be used starting at 10 months of age, 400μg per dose, 3-4 times daily for 4 weeks. If unsuccessful, HCG can be continued with intramuscular injection of 1500u weekly for 3 weeks, achieving a testicular descent success rate of 73%.

3. To increase germ cell count postoperatively, Buserelin can be administered immediately, which helps improve future fertility potential.

bubble_chart Cure Criteria

1. Cure

1) After treatment, the testis is located within the scrotum with good blood supply;

2) Inguinal hernia is simultaneously cured.

2. Improvement: The position of the testis has descended compared to before but has not reached the scrotum.