THE ABSENT CRYPTORCHID TESTIS - SURGICAL FINDINGS AND THEIR IMPLICATIONS FOR DIAGNOSIS AND ETIOLOGY

On surgical exploration for impalpable testes, there is often found no thing or a nubbin of tissue at the end of the spermatic vessels. This situation is commonly referred to as an absent testis. Controversy exi sts on how to establish correctly this diagnosis and the degree of inv estigation required. In addition, there is disagreement concerning whe ther an absent testis results from early torsion or endocrinopathic ev ent. What is accepted is that the spermatic vessels are singularly imp ortant in establishing testis location. In this study, the pathologica l findings of 117 cases of absent testis diagnosed by surgical explora tion at our hospital were reviewed. This diagnosis represented 10% of 1,225 patients explored for cryptorchidism from 1985 to 1991. Average patient age at operation was 26.8 months (range 5 months to 14 years). Of these children 78 (67%) presented with an impalpable left testis. At operation 3 patients (3%) underwent laparoscopy only, while all oth ers had groin exploration with or without transperitoneal exposure to ensure identification of spermatic vessels. In 110 cases surgical spec imens or nubbins were excised. Pathological study of these remnants re vealed vas deferens in 89 cases (81%), epididymal tissue in 40 (36%) a nd small amounts of seminiferous tubules with germinal elements in 7 ( 6.4%). Only 26 specimens (24%) had sufficient vascular tissue present to be Suggestive of spermatic vessels. A significant number showed the presence of calcification (35.5%) and hemosiderin (30%) deposits with in the remnant. A subset of patients with absent testis possesses test icular tissue of presumed increased malignant potential. Therefore, su rgical exploration with spermatic vessel identification and remnant re moval is the gold standard for the diagnosis and treatment of the abse nt testis. The surgeon continues to be responsible for spermatic vesse l identification, since the vessels may be recognized at pathological examination in less than 25% of the cases. Also, the common finding of calcification and hemosiderin lends weight to the torsion etiology ov er endocrinopathy for an absent testis.