LNSLNS Surgeons who operate on patients with congenital undescended testis are often confronted with a complex picture of obvious developmental delay. In such cases, the spermatic funiculus is usually sheathed by a patent vaginal process—to the point of an “intraperitoneal” position. Testes and epididymides are occasionally dystrophic and often dissociated. We think that this explains why hormone therapy has not fulfilled the hopes that were invested in this treatment.

On the other hand it is obvious that surgical treatment requires substantial surgical experience and skill because of the delicate structures. The worry is therefore whether the benefit of surgery before the first year of life is completed—which is thus far only hypothetical and not quantitatively defined—is not canceled out by a higher rate of testicular atrophy. Further developments in this respect need to be monitored closely and carefully.

We cannot emphasize enough the necessity of a careful examination of the position of the testes. Too often, retractile (hypermobile) testicles are misdiagnosed as gliding testicles.

The focus on congenital cryptorchidism does not take into account the not so rare patients with secondary ascended testis. Their parents are often confused by the available information—gleaned, for example, on the internet—with regard to the perceived risk of infertility and later degeneration, especially because their sons have usually exceeded the given age limit by some margin. In these cases, a differentiated and reassuring consultation should be offered, because no “primary damage” exists (guidelines).

In view of the long term sequelae and the treatment delivered by doctors from different specialties and institutions, better interdisciplinary cooperation would be desirable to help answer the outstanding questions.
DOI: 10.3238/arztebl.2010.0073a


Dr. med. Karl Becker
Prinz-Albert-Str. 26
53113 Bonn, Germany
drkarlbecker@aol.com
1.
Mathers MJ, Sperling H, Rübben H, Roth S: The undescended testis: diagnosis, treatment and long-term sequelae [Hodenhochstand: Diagnostik, Therapie und langfristige Konsequenzen]. Dtsch Arztebl Int 2009; 106: 527–32 VOLLTEXT
1. Mathers MJ, Sperling H, Rübben H, Roth S: The undescended testis: diagnosis, treatment and long-term sequelae [Hodenhochstand: Diagnostik, Therapie und langfristige Konsequenzen]. Dtsch Arztebl Int 2009; 106: 527–32 VOLLTEXT