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Undescended Testis
PptxGenJS Presentation
Prof. Zahid Mahmood
Prof. Zahid Mahmood
1
2026-07-12T03:56:15Z
2026-07-12T03:56:15Z
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بِسْمِ اللَّهِ الرَّحْمَٰنِ الرَّحِيمِIn the name of Allah, the Most Gracious, the Most MercifulPK
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Undescended Testis(Cryptorchidism)Prof. Zahid MahmoodMBBS, FCPS — General & Laparoscopic SurgeonPK
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Did You Know?About one in twenty-five boys is born with this.Most testes come down within a few months.An empty scrotum at one year needs surgery.An undescended testis raises the cancer risk.Even surgery does not fully remove that risk.PK
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Learning OutcomesDefine undescended testis.Trace the normal path of descent.Separate undescended, ectopic and retractile testes.List the risks and complications.Plan the timing and type of surgery.PK
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DefinitionFailure of the testis to descend.It stops along its normal path.The scrotum is empty on that side.Present from birth in affected boys.Also called cryptorchidism.PK
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Normal Testicular DescentTestis forms high on the back wall.The gubernaculum guides it downward.It reaches the deep ring by seven months.It passes through the inguinal canal.It enters the scrotum before birth.PK
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TypesUndescended — arrested on the normal path.Ectopic — strays outside the normal path.Retractile — pulled up by the cremaster muscle.Retractile testis is normal, needs no surgery.Ascending — was down, later rises up.PK
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Sites of ArrestInside the abdomen — intra-abdominal.Within the inguinal canal.At the superficial inguinal pouch.High in the upper scrotum.Or the testis may be absent.PK
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IncidencePresent in about three percent of newborns.Much more common in premature babies.Most descend in the first few months.About one percent remain at one year.The right side is affected most often.PK
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Clinical FeaturesThe scrotum is empty and underdeveloped.The testis may be felt in the groin.Sometimes the testis cannot be felt.Usually there are no symptoms.Often found on routine examination.PK
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ExaminationExamine in a warm, relaxed setting.Use warm hands to prevent retraction.Milk the groin towards the scrotum.Note whether the testis stays down.A retractile testis can be brought down.PK
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InvestigationsDiagnosis is mainly by examination.Ultrasound is of limited value.Laparoscopy locates an impalpable testis.It is the best test for this.Hormone tests confirm testicular tissue if needed.PK
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Why We TreatReduced fertility, worse if both sides.Higher risk of testicular cancer.Risk of torsion of the testis.Injury against the pubic bone.Often an associated inguinal hernia.PK
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Malignancy RiskUndescended testes carry a higher cancer risk.Seminoma is the common type.Surgery lowers but does not remove risk.Scrotal position allows easy self-examination.Teach the patient to examine himself.PK
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Treatment — OrchidopexyThe main treatment is orchidopexy.The spermatic cord is fully mobilised.Any hernia sac is tied off.The testis is placed in a dartos pouch.Best done by twelve to eighteen months.PK
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Treatment — Difficult CasesAn impalpable testis is assessed by laparoscopy.An intra-abdominal testis is brought down.Fowler–Stephens is used for high testes.It may be done in two stages.An adult undescended testis is often removed.PK
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Timing of SurgeryOperate early to protect fertility.Ideally by twelve to eighteen months.Do not delay beyond two years.Earlier surgery gives better outcomes.Review any late-ascending testis.PK
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Take-Home MessageAn empty scrotum needs careful examination.Always separate retractile from truly undescended.Perform orchidopexy by twelve to eighteen months.Watch for infertility, cancer and torsion.Use laparoscopy for an impalpable testis.PK
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AssessmentTen Single-Best-Answer QuestionsPK
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MCQ 1A newborn boy has an empty right scrotum. A testis is felt in the inguinal canal along the normal line of descent. This is:A. Retractile testisB. Undescended testisC. Ectopic testisD. Absent testisE. HydroceleKey: BPK
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MCQ 2A boy's testis lies in the superficial inguinal pouch, lateral to the external ring, off the normal path of descent. This is:A. Undescended testisB. Retractile testisC. Ectopic testisD. Ascending testisE. Intra-abdominal testisKey: CPK
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MCQ 3A 3-year-old's testis can be gently milked into the scrotum, where it stays. It rises again when he is cold. The correct management is:A. OrchidopexyB. OrchidectomyC. Reassurance and observationD. hCG injectionsE. LaparoscopyKey: CPK
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MCQ 4A 9-month-old has a unilateral undescended testis palpable in the canal. The optimal timing for orchidopexy is:A. At birthB. 6–18 monthsC. At 5 yearsD. At pubertyE. In adulthoodKey: BPK
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MCQ 5A 1-year-old boy has an impalpable right testis. The most reliable investigation to locate it is:A. UltrasoundB. CT scanC. MRID. LaparoscopyE. Plain X-rayKey: DPK
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MCQ 6Parents ask about the future risks of their son's undescended testis. Compared with a normal testis, it carries an increased risk of:A. HydroceleB. Testicular cancerC. VaricoceleD. Epididymal cystE. ProstatitisKey: BPK
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MCQ 7During orchidopexy for an undescended testis, the surgeon most commonly finds an associated:A. Hydrocele of the cordB. Patent processus vaginalis (hernia sac)C. VaricoceleD. Epididymal cystE. Femoral herniaKey: BPK
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MCQ 8At laparoscopy a high intra-abdominal testis has a short vascular pedicle that prevents it reaching the scrotum. The appropriate procedure is:A. Simple orchidopexyB. Fowler–Stephens orchidopexyC. OrchidectomyD. Hormonal therapyE. ObservationKey: BPK
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MCQ 9A 30-year-old man has a unilateral intra-abdominal testis with a normal contralateral testis. The recommended management is:A. OrchidopexyB. ObservationC. OrchidectomyD. hCG therapyE. Biopsy onlyKey: CPK
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MCQ 10After successful orchidopexy a patient is told the cancer risk is reduced but not abolished. The main benefit of the scrotal position is that it:A. Improves appearance onlyB. Allows easy self-examinationC. Removes the cancer riskD. Cures infertilityE. Prevents torsion completelyKey: BPK
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Thank You“In children's surgery, timing is everything.A small operation at the right agecan protect a child's fertility and future.Examine every newborn — never assume.”Prof. Zahid MahmoodPK
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7/23/19Click to edit Master text stylesSecond levelThird levelFourth levelFifth level‹#›PK
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