MC congenital abnormality of GU tract

If BL undescended get chromosomal studies

Sx: hypoplastic scrotum and inguinal fullness

If you cannot feel testes in inguinal canal you need surgical exploration next. Imaging not very good.

Retractile testis - able to bring from resting location in inguinal canal into the scrotum

Follow up with repeat scrotal exam in 12 mo until puberty begins

Retractile testis can become undescended and require intervention

MC location → superficial inguinal ring

Can be anywhere in the retroperitoneum, ectopic or vanished

Inguinal hernias are common

MC get seminoma. 5X risk if unilateral, 10 X if BL

• CA risk initially → Gonadoblastoma
• Long term risk is Seminoma (better prognosis)

CA risk stays the same even if testicles brought to scrotum

Infertility risk decreases but STILL NOT NORMAL if cryptorchidism is corrected

There is a risk of torsion in undescended testes

Wait until 6 months to repair

Tx: orchiopexy through inguinal incision AND high ligations of processus vaginalis

• If unable to get testes down due to length Ligation spermatic vessels (testicular vessel). Artery of vas will collaterize
• Want orchiopexy done by TWO YEARS OLD
• Inguinal orchiopexy - inguinal incision and opening of the external oblique fascia, ID, and dissection of the inguinal hernia sac and creation of a Dartos pouch
• Intra-abdominal testes that can’t be mobilized adequately for standard orchiopexy → divide testicular vessels
  • Differentiates a Fowler-Stephens orchiopexy
• No difference in testicular survival when comparing primary and 2-stage Fowler-Stephens orchiopexy for non-palpable R testis
  • Delaying orchiopexy for 3-6 mo after division of the testicular vessels confers no significant testicular survival advantage over performing the orchiopexy at the time of vessel division
  • Not necessary to repair hernia defect since the indirect sac is disconnected from the peritoneum during the mobilization of the testicle and the vas