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Undescended testes in children : the paediatric urologist point of view

P Mouriquand, Paediatric Urology, Claude-Bernard University - Lyon 1, Bron, 69500, France

Correspondence: Pierre Mouriquand, Email: pierre.mouriquand{at}chu-lyon.fr

Abstract

Undescended testes (UDT) are found in 1% boys at the age of 1 year old, 3% of full term male infants and 33% in premature babies at birth. Spontaneous descent is possible until 6 months of age.

The two main phases of descent of the testis during gestation are described as well as the possible aetiologies, the consequences of an abnormal migration and the main locations of UDTs.

Clinical examination is essential and should be done in optimal conditions. Laparoscopic exploration is the only valuable complementary investigation in case of non palpable UDT.

Four main situations should be distinguished:

Isolated unilateral palpable UDT without associated genital anomalies which requires a straightforward orchidopexy without other investigations.

UDT with associated genital anomalies which requires a genetic and endocrine assessment.

Unilateral non palpable UDT which requires a laparoscopic exploration which will determine if there is a testis, if it is preservable, if it can be brought down in 1 or 2 steps.

Bilateral non palpable testes which should raise three questions:

Is this child a boy ? Karyotype; 17 OH Progesterone

Are the testes present ? HCG test / AMH / FSH-LH

Where are the testes ? Laparoscopy:One or 2 stage orchidopexy

Differential diagnosis are the retractile testes, anorchidy and CAH. The issue of the ascending testis is approached.

Consequences of UDTs on testicular development, fertility and tumours are discussed as well as the various therapeutic options and the follow up.