The undescended testis: Putting the pieces together

This thesis deals with various aspects of acquired undescended testes. The aim of the work presented in this thesis is to elucidate different aspects of acquired undescended testes and how this should be treated. Additionally, a practical reference chart of normal testicular volumes for 0 to 18 year old boys, as measured using a Prader orchidometer and ultrasound, is presented.
In our clinical studies we included boys with acquired undescended testes who were operated on at the time of diagnosis. Long-term effect on testicular volume and fertility potential of orchidopexy at diagnosis was compared to boys with acquired undescended testes treated with a conservative policy, whereby spontaneous descent until puberty was awaited. When compared to normative values, we found that the testicular volume in boys with a history of acquired undescended testes was smaller at all ages, after orchidopexy. Testicular volume is also smaller in boys in whom spontaneous descent until puberty is awaited. Consequently, we found that fertility potential is compromised in men with a history of acquired undescended testes following orchidopexy at diagnosis, similarly to men in whom spontaneous descent until puberty is awaited. The results of our studies suggest that acquired undescended testes merely represents a portion of the spectrum of undescended testes, that testicular volume is compromised at all ages, and that orchidopexy at diagnosis does not seem to restore the long-term outcome. An important conclusion of this thesis is that any testis that does not remain in the scrotum during childhood may suffer primary and/or secondary degeneration regardless of its etiology or treatment.