Maldescensus Testis
Maldescensus testis (MT) represents the most frequent congenital anomaly of the genitourinary tract and is found in roughly 1 % of mature and in up to 30 % of premature male neonates [1]. Maldescensus testis can be subdivided in two forms: retentio testis
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47
Atiqullah Aziz, Wolfgang H. Rösch, and Maximilian Burger
47.1
Background
Maldescensus testis (MT) represents the most frequent congenital anomaly of the genitourinary tract and is found in roughly 1 % of mature and in up to 30 % of premature male neonates [1]. Maldescensus testis can be subdivided in two forms: retentio testis vs. ectopic testis (Fig. 47.1). Retentio testis describes an incomplete descensus of the testicles positioned within the physiological localizations of the embryological testicular pathway, i.e., abdomen (retentio testis abdominalis, “nonpalpable testis”), inguinal (retentio testis inguinalis), and prescrotal (retentio testis praescrotalis, “gliding testis”) regions. The clinical term “cryptorchidism” is a synonym for MT [2]. Maldescensus testis has to be differentiated from retractile testis, a norm variant of descended testicles, predominantly localized in the scrotum and lifted into the inguinal regions by a strong cremasteric reflex upon palpation [2]. Ectopic testis describes a complete descensus of the testicle; however, the testicles are misdirected outside the physiological embryological testicular pathway. While the most frequent localization in ectopic testis is the superficial inguinal region,
A. Aziz (*) Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Landshuter Str. 65, Regensburg 93053, Germany Department of Pediatric Urology, St. Hedwig University Medical Center of Regensburg, Steinmetzstr. 1-3, Regensburg 93049, Germany e-mail: [email protected] W.H. Rösch Department of Pediatric Urology, St. Hedwig University Medical Center of Regensburg, Steinmetzstr. 1-3, Regensburg 93049, Germany e-mail: [email protected] M. Burger Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Landshuter Str. 65, Regensburg 93053, Germany e-mail: [email protected] A.S. Merseburger et al. (eds.), Urology at a Glance, DOI 10.1007/978-3-642-54859-8_47, © Springer-Verlag Berlin Heidelberg 2014
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A. Aziz et al. Retentio testis
Testicular ectopy
Retentio testis abdominalis (intra-abdominal testicle)
Prefascial ectopy
Retrovesical ectopy Retentio testis inguinalis (Inguinal testicle)
Penile ectopy
Retentio testis prescrotalis (gliding testicle)
Femoral ectopy
High scrotal testicle Perineal ectopy
Fig. 47.1 Localizations [7]
it can be positioned in the perineal, femoral, or suprapubic region or in the contralateral hemiscrotum. Table 47.1 gives a brief summary of the several forms of MT. While the exact pathophysiology of MT remains unclear, intrauterine insufficiency of the hypothalamic-pituitary-gonadal axis is related to a transient, prenatal, and prepubertal hypogonadotropic hypogonadism. Risk factors of MT reported to date include preterm delivery [3], birth weight under 2.5 kg [3], placental insufficiency with reduced secretion of human chorionic gonadotropin (hCG) [3], low maternal estrogen levels [4], maternal smoking [5], and diabetes mellitus [5].
47.2
Symptoms, Clas
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