PEDIATRICS Vol. 36 No. 5 November 1965, pp. 786-788
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DIAGNOSIS AND TREATMENT: THE UNDESCENDED TESTICLE

Alfred M. Bongiovanni M.D.1

1 Physician-in-Chief, Children's Hospital of Philadelphia, Professor and Chairman, Department of Pediatrics, University of Pennsylvania

THE QUESTION of the management of cryptonchidism remains vexing and controversial. Perhaps the major argument centers on the ideal age for treatment and the outcome to be anticipated. So much has been written from the single viewpoint of an individual clinical experience that the varying conclusions attest mainly to the disagreement among authorities. Indeed, it is not at present possible to arrive at a single plan of action which will provide ideal results in the majority of cases. With any plan the outcome will depend also to some extent upon surgical skill and practice.

It has long been regarded as injurious to the human testis to remain above the scrotum. Yet, in certain species the testes do not descend until well after birth and in some seasonal breeders the morphologic and functional states of the gonads vary from intra-abdominal to scrotal position without deleterious effects. In man the testes generally descend between the eighth to ninth fetal month. However, it is recognized that a variable number of newborn male infants—estimated between 1 and 10%, and higher in prematures—have undescended testes which, in more than half the cases, subsequently migrate to their normal position, usually within the first year of life. There is no reason to suspect damage to these organs when descent occurs in early life, and realization of this justifies dismissal of any consideration of treatment during early infancy. Thus, in certain infants with cryptonchidism, the testes will descend spontaneously. It has also been stated that spontaneous descent will occur in a smaller number of instances after the first year of life and even up to the time of puberty.