LATE PRESENTATION OF CRYPTORCHIDISM - THE ETIOLOGY OF TESTICULAR RE-ASCENT

Purpose: We reviewed the records of 21 boys who had 23 previously docu mented descended testes that reascended and who underwent orchiopexy d uring a 2-year period. Materials and Methods: We retrospectively revie wed a 2-year experience in 103 boys (115 undescended testes) who under went orchiopexy in 1988 and 1989. Results: In our 2-year experience 21 of the 103 boys with undescended testes had multiple recorded confirm ations of testicular descent in the past. Of the boys 40% had previous ly been examined in the office or with general anesthesia by a pediatr ic urologist or pediatric surgeon for another reason, and 40% had a nu rse or physician parent. Surgery was performed at ages 5 to 14 years, an average of 2 years after the initial presentation with reascent. Hu man chorionic gonadotropin was unsuccessful in causing testicular desc ent. There was no correlation with a patent processus vaginalis and no association with adhesions. The testis was located in the superficial inguinal pouch in the majority of patients, and the gubernacular atta chment was in an abnormal location in all and ectopic in half of the c ases. Conclusions: Our observations confirm that the etiology of this condition is a missed diagnosis at a younger age. The testis is undesc ended but almost completely descended. With somatic growth the distanc e between the terminal portion of the gubernaculum of the apparently d escended testis and the scrotum increases, making the diagnosis more o bvious. The potential for this condition makes it mandatory that intra scrotal testicular location be confirmed by periodic physical examinat ion through puberty.