Different surgical findings in congenital and acquired undescended testes

Study Type – Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Much is known on the aetiology, natural course and treatment of congenital undescended testes (UDT), but these matters are less clear for acquired UDT and still debated. Several studies have examined anatomical findings in patients with UDT. However, most of these studies do not distinguish between congenital and acquired UDT. This study describes clinical and surgical differences between congenital and acquired UDT, in which full history was known for all patients. Major differences were found in preoperative testis position as well as intraoperative testis position, patency of processus vaginalis and epididymal anomalies between congenital and acquired UDT. OBJECTIVE To compare surgical findings in congenital and acquired undescended testes (UDT). PATIENTS AND METHODS A review of 139 boys with 158 congenital UDT and 69 boys with 84 acquired UDT was performed. The most caudal testicular position preoperatively, testis position at surgery, patency of the processus vaginalis and epididymal anomalies were prospectively recorded. RESULTS In the congenital group, orchiopexy had been performed at median age (range) 4.9 (1.5–14.6) years, while the median age (range) in the acquired group was 11.9 (3.8–23.3) years. Preoperatively, only congenital UDT were found not palpable or emergent inguinal, while only acquired UDT could be manipulated in an unstable scrotal position. In comparison with congenital UDT, acquired UDT were significantly more often located at the scrotal entrance, 27/158 vs 32/84 respectively ( P < 0.001). At surgery anorchia, vanished testis or testes lying intra‐abdominally were only registered in the congenital UDT group. Also 37/158 congenital UDT were located in the superficial inguinal pouch vs 52/84 of the acquired UDT ( P = 0.04). In congenital UDT the processus vaginalis was wide open in 74/158, while in acquired UDT the processus vaginalis was closed in 46/84 ( P < 0.001) and small open in 26/84 ( P = 0.04). Epididymal anomalies were more often seen in the congenital UDT group (37%) than in the acquired group (11%). CONCLUSION The most caudal position of congenital UDT after manipulation before surgery was at the scrotal entrance. These testes were frequently associated with epididymal anomalies and wide open processus vaginalis. This was in contrast to acquired UDT, which can often be pushed down well below the scrotal entrance and are more likely to be situated in the superficial inguinal pouch, with a normal epididymis and closed processus vaginalis.