Criptorquidia y otras anomalías del descenso testicular

Title: Cryptorchidism and other abnormalities of testicular descent Cryptorchidism or undescended testis is the most common abnormality of the male endocrine glands during childhood. This term indicates empty scrotum, secondary to a failure in the descent mechanism. The incidence of cryptorchidism in full-term newborn infants ranges between 3.4% and 5.8%. The major reasons for treating the undescended testis are: reduced fertility in patients with unilateral or bilateral cryptorchidism, higher incidence of malignant neoplasms, higher risk of testicular torsion or injury due to compression against the pubic bone and psychological problems provoked by empty scrotum. Chromosomal abnormalities play an important role in the etiology of cryptorchidism, and undescended testis is a common component of more than 50 syndromes involving congenital abnormalities. The diagnosis of cryptorchidism is based on the medical history and physical examination of the patient, detailed description of the testicular position and size, comparison with the contralateral testicle, scrotal development and mobility, presence or absence of the cremasteric reflex, size and morphology of the scrotum and penis, and signs of inguinal hernia. Cases can be classified, according to location, as impalpable or palpable testes and by making the proper distinction between cryptorchidism (the testis is located in the abdominal cavity, in the inguinal region, just outside the inguinal canal or in the apex of the scrotum) and testicular ectopia. In the case of unilateral or bilateral palpable undescended testes, analytical evaluation to confirm the diagnosis is unnecessary. Hormone replacement therapy with human chorionic gonadotropin (HCG) is recommended for distal inguinal testis and when the testis is located in the apex of the scrotum. Treatment for unilateral or bilateral palpable testes is orchidopexy. In the case of impalpable testes, we recommend making an inguinal incision to explore the inguinal canal. If the testicle is found to be normal, we perform orchidopexy; if atrophic testes or testicular remnants are encountered, they are excised; and if we find no remnants in the inguinal canal, we perform laparoscopic inspection of the abdominal cavity. Finally, the current treatment of choice for intraabdominal testis is laparoscopic orchidopexy.