Maldescensus testis Q53.95

Author: Prof. Dr. med. Peter Altmeyer

Last updated on: 29.10.2020

Synonym(s)

Cryptorchidism; ectopia testis; Pendulum testicles; retentiontio testis; Sliding testicles; Testicular kidney; Testicular retention

Definition
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Absence of the Descensus testis (one or both sides). The testes normally lie in the scrotum at birth (96-97%), but should be descended by the end of the first year of life at the latest, as the physiological development of the testes occurs only in the case of (predominantly) intrascrotal position.

Clinical features
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According to the position of the testis different forms are distinguished, see table 1.

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Differential diagnosis
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Testicular aplasia in the case of retention testis abdominalis and ectopia testis, inguinal hernia in the case of retention testis inguinalis.

General therapy
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By urologists or pediatricians. With the exception of the sliding or pendulum testis, any positional anomaly should be treated between 3 months and 2 years of age. It is recommended to start therapy at the age of 10 months.

Internal therapy
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Initially already in the 10th month of life GnRH (e.g. Kryptocur) intranasally over 4 weeks, 3 times/day 1 spray in each nostril, wait for results over 2-4 weeks. In the absence of success, parenteral HCG therapy (e.g. Predalon) with approx. 500-1500 IU/week (depending on age, pediatrician!) over 3-4 weeks.

Operative therapie
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If conservative treatment is unsuccessful (approx. 3-4 months after hormonal therapy), surgical treatment with orchidopexy by urologists. Before surgical therapy, renewed HCG cycle over 3-5 weeks, 2 times 250 IU HCG/week, in older children (6-12 years) or in adolescents increase the dose to 2 times 500 up to max. 2 times 1000 IU HCG/week over the same period.

Ectopic testicles are primarily removed surgically because of the danger of degeneration.
In case of pendulum testis which do not remain permanently intrascrotal at the end of puberty, surgical treatment by orchidopexy.

Progression/forecast
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If the tests are retained beyond the age of 6 years, the germinal epithelium shows considerable damage, which can make a later sufficient spermiogenesis (fertility) impossible. Increased risk of degeneration of retained testicles!

Tables
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Classification of the maldescensus testis

Classification	Clinic	Therapy
Retentio testis abdominalis (abdominal testicles)	Testicles not palpable.	Hormonal, possibly surgical.
Retentio testis inguinalis (inguinal testicles)	Testicles in the inguinal canal or in front of the outer inguinal ring palpable, cannot be relocated into the scrotum.	Hormonally, if necessary surgically.
Testis mobilis (sliding or pendulum testis)	Sliding testis: Under tension of the spermatic cord structures the testis can be shifted to the upper scrotum. Afterwards it immediately slides back into the inguinal position.	Not in need of treatment. Regular control. At the end of puberty often permanent intrascrotal positioning, otherwise operative.
Testis mobilis (sliding or pendulum testis)	Pendulum testis: Can be moved permanently into the scrotum. The testis "swings" back into the inguinal canal only occasionally.
Ectopia testis	Displacement of the testis outside the physiological descensus pathway, e.g. perineal, retroperitoneal.	Surgical removal.