Clinical Pediatrics and Pediatric Surgery

Undescended testes (UDT) remain common, with increasing evidence that acquired UDT or the ascending testis syndrome should be considered part of the spectrum in this pathology. Between 0.5 to 9% of boys may be affected depending on the quality of ascertainment, reporting, geographic location and age at presentation. There appears limited value for the use of ultrasound in the diagnosis, although it remains widely used and does not reliably differentiate between UDT and retractile testes. Prompt diagnosis and early referral for surgical evaluation and treatment would seem most likely to result in an optimal functional and cosmetic outcome as well as reducing the risks of torsion and faciltating diagnosis of any subsequent malignancy. Hormonal treatment, rather than orchidopexy, remains popular in some centers despite lack of good evidence to support its efficacy, although it may have an important adjunct role in optimizing fertility. Debate continues over the optimal surgical approach while performing an orchidopexy, whether initially laparoscopic, single or staged, a traditional inguinal open approach or via a parascrotal incision. The testis, rather than quiescent, appears biologically active in the male infant with increasing evidence of an adverse impact on future spermatogenesis and fertility in males with an UDT. Whilst not definitive, there would seem to be an increasing consenus on the value, in terms of future fertility, of earlier orchidopexy before 12 months of age. The need for earlier surgery has to be balanced against the potential risks of operative intervention and general anasethesia.