A review of surgical treatment of undescended testes with emphasis on anatomical position.

We reviewed our 5-year surgical experience with undescended testes in 295 patients. Surgery had been performed in a standardized fashion to identify accurately testicular position. Before opening the fascia of the external oblique muscle, the superficial inguinal pouch and area beyond the external ring were explored carefully. Testes beyond the external ring were defined as ectopic. Other positions identified included intracanalicular and intra-abdominal. Of 336 testes 66 per cent were ectopic, 16 per cent intracanalicular, 10 per cent abdominal and 3 per cent absent. Maldescent was unilateral in 254 patients and bilateral in 41. In the unilateral cases of 178 testes were ectopic (70 per cent) and the testis was palpable preoperatively in 158 (89 per cent). Bilateral undescended testes were palpable on both sides preoperatively in 25 of 41 cases (61 per cent), including 16 (64 per cent) ectopic testes. There were 10 cases of bilateral nonpalpable testes and in 8 (80 per cent) both testes were intra-abdominal. Based on the high incidence of ectopic testes and their associated abnormal attachments, it is our prediction that nonsurgical treatment (hormonal) of undescended testes would not be expected to achieve optimal results.