Summary
Introduction
About 0.8% of boys have undescended testes at 1 year of age. However, the overall
rate of orchidopexy is 2.5 times that expected. While studies have shown ascending
testes accounting for a proportion of such discrepancy, the aetiology of this ascent
remains controversial. In this study, intra-operative findings of patients underwent
orchidopexy for ascending testes are evaluated to infer aetiology.
Methods
Patients with confirmed ascending testes from a single paediatric surgery unit over
a four-year period from June 2015 till June 2019 were included in this observational
study. During orchidopexy procedure, intra-operative findings in terms of gubernacular
attachment, and the degree of epididymal attachment to the upper pole of the testicle
were primarily evaluated. Secondary findings including the presence and length of
patent processus vaginalis (PPV), and the presence of any long looping vas or hydatid
of morgangi were also noted.
Results
Eighty-three children (median age = 79 months [range 38–149]) were included in this
study. Two boys had bilateral ascending testes leading to a total of 85 orchidopexy
cases performed. All patients were found to have a gubernacular attachment proximal
to the junction between the upper lateral wall of scrotum and the medial part of the
thigh. PPV was present in all cases, with its length measured from the deep inguinal
ring after retracting the conjoint tendon ranging from 4 to 15 mm 84 cases (98.8%)
demonstrated complete or partial separation between the head of epididymis and the
upper pole of the testicle. Hydatid of morgagni was present in 82 cases (96.4%), and
none of the operated testicles demonstrated looping vas.
Discussion
The varying degrees of PPV length demonstrated during orchiodpexy for ascending testes
in this study casts a doubt on the role of processus vaginalis in such ascent. Also,
there is considerably a wide-range of reported incidence (13–78%) in literature for
PPV in ascending testes.
In this study, intra-operative findings demonstrated an abnormal gubernaculum attachment
in all ascending testes in keeping with previous reports, and support the hypothesis
that ascending testis has always been undescended, yet acquired more apparent undescended
position with child age and growth.
Conclusion
Table Summary
| Intra-operative findings in orchidopexy for ascending testes | Incidence % |
|---|---|
| Abnormal gubernaculum attachment | 100 |
| PPV present with varying length | 100 |
| Complete or Partial separation between head of epididymis and upper pole of testis | 98.8 |
| Hydatid of Morgagni | 96.4 |
| Looping Vas | 0 |
Keywords
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Article info
Publication history
Published online: December 19, 2020
Accepted:
December 16,
2020
Received in revised form:
December 11,
2020
Received:
November 27,
2020
Identification
Copyright
© 2020 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
