Undescended Testis and Orchiopexy: Recent Observations
Charles E. Hawtrey MD1
1 Professor of Urology, Vice-Chairman, Department of Urology, University of Iowa College of Medicine, University of Iowa Hospitals and Clinics, Iowa City
Within the past two decades, observations from a number of sources have expanded our understanding of undescended testes in children. As neonatology has grown, the observations of infants with low birth weight and knowledge of the implications of this condition for undescended testes have also increased. Information obtained from biopsy, including that from studies using electron microscopy, has suggested decreased spermatogonia in children with abdominal testes with age, indicating a need for medical or surgical intervention soon after 1 year of age. The effects of orchiopexy and hormonal manipulations to assure fertility in adulthood have been clarified to the extent that an algorithm for patient management can be constructed.
ANATOMY
An undescended testis has been identified in 0.8% of male infants at 1 year of age1 and in about 0.2% of adult male military recruits. The incidence rises to 21% in premature neonates weighing less than 2,500 g. Even more striking, nearly 100% of profoundly low-birth-weight neonates (weighing approximately 900 g) exhibit bilateral undescended testes. With weight gain and age, the testes of infants who weighed 900 g at birth proceed toward descent and at 1 year of age have the same incidence as their peers.
Many authors in Europe and the United States have noted that scrotal descent of the testis by 3 years of age preserves spermatogonia, implying a beneficial effect on adult fertility.
