UDT Nomenclature Kaplan
3
Eur J Pediatr (1993) 152 [Suppl 2] : S 17-S 19 uropean Journal of ediatrics 9 Springer-Verlag 1993 omenclature of cryptorchidism George W Kaplan Division of Urology, Department of Surgery, University o f California at San Diego, School of Medicine, San Diego, CA 92123, USA Abstract Despite the fact that cryptorchidism is a com- mon congenital anomaly, our understanding of this prob- lem is hampered by confusion and uncertainty regarding diagnosis and treatment. A major factor producing this confusion is the lack of a common terminology that de- scribes to the reader (or listener) exactly what the author means by a given term. Herein is proposed a classification system that, if adopted and utilized, could amoliorate this problem. Key words: Cryptorchidism - Classification, nomencla- ture Cryptorchidism is a very common congenital anomaly and yet, despite its frequency, there is a great deal of con- fusion and uncertainty about many aspects of its etiology, natural history, and treatment. Any student of the litera- ture on cryptorchidism will quickly realize that terminol- ogy differs among authors and that a precise definition of the terms employed is often lacking. I strongly suspect that this lack of a uniform glossary explains many of the vagaries that are observed in the literature. If everyone were utilizing the same terminology, it seems most un- likely that there could be such marked disparity in the ob- served incidence of the lesion and in the results of expec- tant or hormonal treatment of so common a lesion. This might similarly explain permanent testicular ascent, a concept which I personally have great difficulty accept- ing. There have been other attempts at classification but none have proven entirely satisfactory for clinical pur- poses. [9] Whitaker has pointed out that a classification can be based on position at palpation, after manipulation, or at operation. [13] It seems to me that position after ma- nipulation is too dependent upon variables that could vary among examiners, examinees, and examination techniques to be useful for comparisons between institutions. With this exception, the following classification is very similar to Whitaker's. However, it was developed independently from his and was first presented before his report ap- peared. [7, 8, 13] Correspondence to G.W. Kaplan, 7930 Frost Street, Suite 407, San Diego, CA 92123, USA To organize an approach to classification of cryptorchid testes, certain assumptions are necessary. Some are based upon prior observations from the literature, some are con- sidered truisms, and some are personal prejudices. These assumptions are as follows: a. If no testis develops, there will be Mtillerian structures present ipsilaterally. [5] b. If the testis develops but the processus vaginalis does not form, the gubernaculum will not form and the tes- tis will be intra-abdominal. [1] c. The incidence of undescended testes at birth is 3-4% but roughly 75% of newborn undescended testes will descend spontaneously within the first few months of life. [ 12] d. It is assumed that testicular descent is complete by nine months of age because the incidence of cryptor- chidism between 9 and 12 months is roughly 0.8%; an identical incidence has been observed after puberty. [12] e. The cremasteric reflex at birth and for the first several months of life is said to be weak to absent; [12] hence any testis that is completely descended at the time of an examination during early infancy should be classi- fied as normally descended. A testis that is normally descended in infancy may at times be retractile but with this exception should never become undescend- ed. Nevertheless, there now are reports of "ascending testes". [2, 14] If assumption "e" is correct, the con- cept of testicular ascent seems untenable. f. Similarly, the cremasteric reflex should be abolished by general anesthesia [14] so that any testis that is not at the scrotal base when the patient is anesthetized is presumably not completely descended. g. If a testis descends after nine months of age, this pre- sumably is evidence of testicular retractility rather than evidence of late descent of an undescended testis (if assumption "d" is correct). h. Because testicular retractility is thought to be a normal variant, it should not impair eventual fertility. [11] Nevertheless, changes in histology and semen analy- ses have been reported in patients with presumed re- tractile testes. [10, 3, 4] i. Re-ascent of the testis within the first 9 months of age after initial descent without subsequent re-descent prior to puberty is evidence of initial misdiagnosis of testicular position.
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Transcript of UDT Nomenclature Kaplan
7/27/2019 UDT Nomenclature Kaplan
http://slidepdf.com/reader/full/udt-nomenclature-kaplan 1/3
Eur J Pediatr (1993) 152 [Suppl 2] : S 17- S 19 EuropeanJournalof
P e d i a t r i c s9 Springer-Verlag1993
N o m e n c l a t u r e o f c r y p t o r c h id i s m
G e o r g e W . K a p l a n
Division of Urology, Department of Surgery, University o f California at San Diego, School o f Medicine, San Diego, CA 92 123, USA
Abstract . D e s p i t e t h e f a c t t h a t c r y p t o r c h i d i s m i s a c o m -
m o n c o n g e n i t a l a n o m a l y , o u r u n d e r s t a n d i n g o f t h is p r o b -
l e m i s h a m p e r e d b y c o n f u s i o n a n d u n c e r t a i n t y r e g a r d i n g
d i a g n o s i s a n d t r e a t m e n t . A m a j o r f a c t o r p r o d u c i n g t h i s
c o n f u s i o n i s t h e l a c k o f a c o m m o n t e r m i n o l o g y t h a t d e -
s c r i b e s t o t h e r e a d e r ( o r l i s t e n e r ) e x a c t l y w h a t t h e a u t h o r
m e a n s b y a g i v e n t e r m . H e r e i n i s p r o p o s e d a c l a ss i f ic a t i o ns y s t e m t h a t , i f a d o p t e d a n d u t i l i z e d , c o u l d a m o l i o r a t e t h i s
p r o b l e m .
K e y w o r d s : C r y p t o r c h i d i s m - C l a s si f ic a t i o n , n o m e n c l a -
t u r e
C r y p t o r c h i d i s m i s a v e r y c o m m o n c o n g e n i t a l a n o m a l y
a n d y e t , d e s p i t e i t s f r e q u e n c y , t h e r e is a g r e a t d e a l o f c o n -
f u s i o n a n d u n c e r t a i n t y a b o u t m a n y a s p e c ts o f it s e t io l o g y ,
n a t u r a l h i s t o r y , a n d t r e a t m e n t . A n y s t u d e n t o f t h e l it e r a -
t u r e o n c r y p t o r c h i d i s m w i l l q u i c k l y r e a l iz e t h a t t e r m i n o l -o g y d i f f e r s a m o n g a u t h o r s a n d t h a t a p r e c i s e d e f in i t i o n o f
t h e t e r m s e m p l o y e d i s o f t e n l a c k i n g . I s t r o n g l y s u s p e c t
t h a t th i s l a c k o f a u n i f o r m g l o s s a r y e x p l a i n s m a n y o f t h e
v a g a r i e s t h a t a r e o b s e r v e d i n t h e li t e r a t u re . I f e v e r y o n e
w e r e u t i l i z i n g t h e s a m e t e r m i n o l o g y , i t s e e m s m o s t u n -
l i k e l y th a t t h e r e c o u l d b e s u c h m a r k e d d i s p a r it y i n t h e o b -
s e r v e d i n c i d e n c e o f t h e l e si o n a n d i n t h e r e s u l ts o f e x p e c -
t a n t o r h o r m o n a l t r e a t m e n t o f s o c o m m o n a l e s i o n . T h i s
m i g h t s i m i l a r l y e x p l a i n p e r m a n e n t t e s t i c u l a r a s c e n t , a
c o n c e p t w h i c h I p e r s o n a l l y h a v e g r e a t d i f f i c u l t y a c c e p t -
ing .
T h e r e h a v e b e e n o t h e r a t t e m p t s a t c l a s s i f i c a t i o n b u t
n o n e h a v e p r o v e n e n t i r e l y s a t i s f a c t o r y f o r c l i n i c a l p u r -p o s e s . [ 9 ] W h i t a k e r h a s p o i n t e d o u t t h a t a c l a s s i f i c a t i o n
c a n b e b a s e d o n p o s i t i o n a t p a l p a t io n , a f t e r m a n i p u l a ti o n ,
o r a t o p e r a t i o n . [ 1 3 ] I t s e e m s t o m e t h a t p o s i t i o n a f t e r m a -
n i p u l a t io n i s t o o d e p e n d e n t u p o n v a r i a b l es t h a t c o u l d v a r y
a m o n g e x a m i n e r s , e x a m i n e e s , a n d e x a m i n a t i o n t e c h n iq u e s
t o b e u s e f u l f o r c o m p a r i s o n s b e t w e e n i n s t i t u t i o n s . W i t h
t h i s e x c e p t i o n , t h e f o l l o w i n g c l a s s i f i c a t i o n i s v e r y s i m i l a r
t o W h i t a k e r 's . H o w e v e r , i t w a s d e v e l o p e d i n d e p e n d e n t l y
f r o m h i s a n d w a s f i r s t p r e s e n t e d b e f o r e h i s r e p o r t a p -
pea red . [7 , 8 , 13]
Correspondence to: G.W. Kaplan, 7930 Frost Street, Suite 407,
San Diego, CA 92123, USA
T o o r g a n i z e a n a p p r o a c h t o c l a s si f i c at i o n o f c r y p t o r c h i d
t e s t e s , c e r t a i n a s s u m p t i o n s a r e n e c e s s a r y . S o m e a r e b a s e d
u p o n p r i o r o b s e r v a t i o n s f r o m t h e l i t e ra t u r e, s o m e a r e c o n -
s i d e r e d t r u i s m s , a n d s o m e a r e p e r s o n a l p r e j u d i c e s . T h e s e
a s s u m p t i o n s a r e a s f o l l o w s :
a . I f n o t e s t i s d e v e l o p s , t h e r e w i l l b e M t i l l e ri a n s t r u c t u r e s
presen t ips i l a te ra l ly . [5 ]b . I f th e t e s ti s d e v e l o p s b u t t h e p r o c e s s u s v a g i n a l i s d o e s
n o t f o r m , t h e g u b e r n a c u l u m w i l l n o t f o r m a n d t h e t e s-
t i s w i l l b e i n t r a - a b d o m i n a l . [ 1 ]
c . T h e i n c i d e n c e o f u n d e s c e n d e d t e s t e s a t b i r t h is 3 - 4 %
b u t r o u g h l y 7 5 % o f n e w b o r n u n d e s c e n d e d t e s t e s w i l l
d e s c e n d s p o n t a n e o u s l y w i t h i n t h e f i r s t f e w m o n t h s o f
l i fe . [ 12]
d . I t i s a s s u m e d t h a t t e s t i c u l a r d e s c e n t i s c o m p l e t e b y
n i n e m o n t h s o f a g e b e c a u s e t h e i n c i d e n c e o f c r y p t o r -
c h i d i s m b e t w e e n 9 a n d 1 2 m o n t h s i s r o u g h l y 0 . 8 % ; a n
i d e n t i c a l i n c i d e n c e h a s b e e n o b s e r v e d a f t e r p u b e r t y .
[12]
e . T h e c r e m a s t e r i c r e f l e x a t b i r t h a n d f o r th e f i r s t s e v e r a lm o n t h s o f l if e i s sa i d t o b e w e a k t o a b s e n t ; [ 1 2 ] h e n c e
a n y t e s t i s t h a t i s c o m p l e t e l y d e s c e n d e d a t t h e t i m e o f
a n e x a m i n a t i o n d u r i n g e a r l y i n f a n c y s h o u l d b e c l a s si -
f i e d a s n o r m a l l y d e s c e n d e d . A t e s t i s t h a t i s n o r m a l l y
d e s c e n d e d i n i n f a n c y m a y a t t i m e s b e r e t r a c t i l e b u t
w i t h t h i s e x c e p t i o n s h o u l d n e v e r b e c o m e u n d e s c e n d -
e d . N e v e r t h e l e s s, t h e r e n o w a r e r e p o rt s o f " a s c e n d i n g
t e s t e s " . [ 2 , 1 4 ] I f a s s u m p t i o n " e " i s c o r r e c t , t h e c o n -
c e p t o f t e s t i c u l a r a s c e n t s e e m s u n t e n a b l e .
f . S i m i l a r l y , t h e c r e m a s t e r i c r e f l e x s h o u l d b e a b o l i s h e d
b y g e n e r a l a n e s t h e s i a [ 1 4 ] s o t h a t a n y t e s t i s t h a t i s n o t
a t t h e s c r o t a l b a s e w h e n t h e p a t i e n t i s a n e s t h e t i z e d i s
p r e s u m a b l y n o t c o m p l e t e l y d e s c e n d e d .g . I f a t e s ti s d e s c e n d s a f t e r n i n e m o n t h s o f a g e, t h i s p r e -
s u m a b l y i s e v i d e n c e o f t e s t i c u l a r r e t r a c t i l i t y r a t h e r
t h a n e v i d e n c e o f l at e d e s c e n t o f a n u n d e s c e n d e d t e st is
( i f a s s u m p t i o n " d " i s c o r r e c t ) .
h . B e c a u s e t e s t i c u l a r r e t r a c t i l i t y i s t h o u g h t t o b e a n o r m a l
v a r i a n t , i t s h o u l d n o t i m p a i r e v e n t u a l f e r t i l i t y . [ 1 1 ]
N e v e r t h e l e s s , c h a n g e s i n h i s t o l o g y a n d s e m e n a n a l y -
s e s h a v e b e e n r e p o r t e d i n p a t i e n t s w i t h p r e s u m e d r e -
t rac t i l e t e s te s . [10 , 3 , 4 ]
i . R e - a s c e n t o f t h e te s t is w i t h i n t h e f i r s t 9 m o n t h s o f a g e
a f t e r i n i t i a l d e s c e n t w i t h o u t s u b s e q u e n t r e - d e s c e n t
p r i o r t o p u b e r t y i s e v i d e n c e o f i n i ti a l m i s d i a g n o s is o f
t e s t i c u l a r p o s i t i o n .
7/27/2019 UDT Nomenclature Kaplan
http://slidepdf.com/reader/full/udt-nomenclature-kaplan 2/3
$1 8
j . L a s t l y , i f t h e p i t u i t a r y g l a n d i s n o r m a l , n e i t h e r c h o r -
i o n i c g o n a d o t r o p i n n o r g o n a d o t r o p i n r e l e a s i n g h o r -
m o n e s h o u l d r e s u l t i n d e s c e n t u n l e s s t h e t e s t i s i s r e -
t r ac t i l e .
g u i n a l p o u c h c o u l d t h e n , d u r i n g i n f a n c y , b e t e m p o r a r i l y
p u l l e d d o w n i n t o t h e s c r o t u m d u r i n g e x a m i n a t i o n , r e s u l t -
in g in in i t i a l misd iag n o s i s .
T o f a c i l i t a t e i n v e s t i g a t i o n a n d c o m m u n i c a t i o n , I w o u l d
l i k e t o p r o p o s e t h e f o l l o w i n g n o m e n c l a t u r e . T h i s i s a c l i n -
i c a l c l a s s i fi c a t i o n a n d i s b a s e d i n p a r t o n t h e p r e v i o u s a s -
s u m p t io n s . E x a m i n a t i o n s a r e c o n d u c t e d i n a w a r m r o o m ,w i t h t h e p a t i e n t s u p i n e , w i t h h i s h i p s e x t e r n a l l y r o t a t e d
a n d a b d u c t e d , a n d w i t h h i s k n e e s f l e x e d . T h e s c r o t u m i s
f i r st v i s u a l l y i n s p e c t e d b e f o r e a n y a t t e m p t a t p a l p a ti o n . I f
t e s t e s a r e t h o u g h t t o b e v i s i b l e i n t h e s c r o t u m , t h e y a r e
" t r a p p e d " i n p o s i t i o n b y ( f o r a r i g h t - h a n d e d e x a m i n e r )
p l a c i n g t h e l e f t t h u m b o v e r t h e p a t i e n t ' s r i g h t s p e r m a t i c
c o r d a t t h e p u b i s a n d t h e l e f t i n d e x f i n g e r o v e r t h e l e f t
s p e r m a t i c c o r d a t t h e p u b i s . T h e t e s t i s i s t h e n p a l p a t -
e d w i t h t h e e x a m i n e r ' s r i g h t t h u m b , i n d e x a n d t h i r d f i n -
gers .
I . P a l p a b l e
A . N o r m a l
W h e n t h e p a t i e n t i s s u p i n e ( o r s t a n di n g ) , t h e t e s t is s h o u l d
b e b o t h v i s i b l e a n d p a l p a b l e a t t h e b a s e o f th e s c r o t u m . N o
m a n i p u l a t i o n s h o u l d b e n e c e s s a r y t o p u t i t th e r e . T h e i p s i -
l a te r a l h e m i s c r o t u m i s e q u a l l y w e l l d e v e l o p e d c o m p a r e d
t o t h e c o n t r a l a t e r a l si d e . T h e p a t i e n t ' s h i s t o r y w i l l c o n f i r m
k n o w n d e s c e n t a t b i r t h o r w i t h i n t h e f i r s t f e w m o n t h s o f
l i fe .
B . R e t r a c t i l e t e s ti s
Wh en th e p a t ien t i s su p in e ( o r s tan d in g ) , th e t e s t i s i s n o t
i n i ts n o r m a l p o s i t i o n a t t h e s c r o t a l b a s e b u t c a n b e l o c a t e d
i n t h e in g u i n a l a r e a a n d m a n u a l l y m o v e d t o th e b a s e o f t h e
s c r o t u m w h e r e i t w i l l th e n r e m a i n f o r s o m e m i n u t e s w i t h -
o u t t r a c t i o n o r " t r a p p i n g " . T h e i p s i l a t e r a l h e m i s c r o t u m i s
a s e q u a l l y w e l l d e v e l o p e d a s t h e c o n t r a l a t e r a l s i d e . T h e
h is to r y i s u su a l ly h e lp f u l in es tab l i sh in g th a t th e t e s t i s w as
p r e v i o u s l y t h o u g h t t o b e d e s c e n d e d . R e t r a c t i l e t e s t e s
s h o u l d d e s c e n d i n r e s p o n s e t o h o r m o n a l m a n i p u l a t i o n
( H C G o r G n R H ) .
C . E c t o p i c t e s t e s
T h e s e t e s t e s h a v e s o m e h o w l e f t t h e p a t h o f n o r m a l d e -s c e n t . T h e y c o m e t o r e s i d e i n t h e s u p e r f i c i a l i n g u i n a l
p o u c h , t h e p e r i n e u m , t h e f e m o r a l c a n a l , t h e p e n o p u b i c
a r e a , o r m a y b e t r a n s v e r s e l y e c t o p i c . T h e i p s i l a te r a l h e m -
i s c r o t u m i s u s u a l l y s m a l l e r t h a n t h e c o n t r a l a t e r a l n o r m a l
s i d e . T h e h i s t o r y i s u s u a l l y h e l p f u l i n t h a t t h e t e s t i s h a d
n e v e r b e e n t h o u g h t t o b e d e s c e n d e d . H o w e v e r , a te s t is l o -
c a t e d i n t h e s u p e r f i c i a l p o u c h m a y , a t b ir t h , s e e m t o b e l o -
c a t e d i n t h e u p p e r s c r o t u m , p r e s u m a b l y b e c a u s e S c a r p a ' s
f a s c i a ( w h i c h f o r m s t h e b o u n d a r y o f t h e s u p e r f i c i a l
p o u c h ) i s a b i t l a x a t t h a t a g e . W i t h t i m e , i t w i l l b e c o m ec lea r th a t th e t e s t i s i s n o t r ea l ly in th e sc r o tu m. I f th i s a s -
s u m p t i o n i s c o r r e c t , a s c e n d i n g t e s t e s m a y t h u s b e e x -
p l a i n e d b e c a u s e s o m e t e s t e s l o c a t e d i n t h e s u p e r f i c i a l i n -
D . U n d e s c e n d e d t e s te s
1 . N o n - e n d o c r i n o p a t h i c
a . T r u e u n d e s c e n d e d t e s t e s . T h e s e t e s t e s a r e l o c a t e d
s o m e w h e r e a l o n g t h e n o r m a l p a t h o f d e s c e n t . T h e i p s i l a t -
e r a l h e m i s c r o t u m i s s m a l l. T h e p a t i e n t' s h i s t o r y u s u a l l y i s
h e l p f ul e x c e p t w h e n t h e r e h as b e e n a h y d r o c e l e e x t e n d in g
c a u d e d t o t h e t e st i s a n d i t is t h e h y d r o c e l e w h i c h h a s f i l l e d
o u t t h e s c r o t u m , l e a d i n g t h e e x a m i n e r t o t h e f a ls e c o n c l u -
s i on t h a t b e c a u s e t h e s c r o t u m w a s v i s i b ly d e v e l o p e d a n d
f u l l , t h e t e s t i s w a s d e s c e n d e d . T h e " g l i d i n g " t e s t i s c o u l d
f i t i n t o e i t h e r t h i s c a t e g o r y o r C a t e g o r y I I A , d e p e n d i n g o n
w h e t h e r i t w a s p a l p a b l e o n a n y g i v e n e x a m i n a t i o n . O n t h e
l e f t s i d e , t h e r e m a y b e a n a s s o c i a t e d s p l e n o - g o n a d a l f u -
s io n .
b . l a t r o g e n i c u n d e s c e n d e d t e s t e s . T h e s e t e s t e s w e r e p r e v i -
o u s l y d e s c e n d e d b u t , f o l l o w i n g a h e r n i a r e p a i r o r s o m e
o t h e r i n g u i n a l o p e r a t i o n , h a v e b e c o m e t r a p p e d i n s c a r
c e p h a l a d t o t h e s c r o t u m . [ 6]
2 . E n d o c r i n o p a t h i c
T h e s e t e s t e s a r e l o c a t e d i n t h e n o r m a l p a t h w a y o f d e s c e n t.
T h e p a t i e n t s a r e u s u a l l y u n d e r - v i r i l iz e d a n d h a v e b i l a t e r a l
n o n - d e s c e n t . T h e r e u s u a l l y i s a d e f i n a b l e l e s i o n t o a c -
c o u n t f o r t h e o b s e r v e d g o n a d o t r o p i n d e f i c i e n c y o r p o o r
t e s t i c u l a r re s p o n s e t o h o r m o n a l s t i m u l a t io n .
I I . N o n p a l p a b l e t e s t e s
A . C a n a l i c u l a r ( " g l i d i n g " )
I n o l d e r c h i l d r e n o r o b e s e b o y s , o n e m a y n o t b e a b l e t o
f e e l a t e s ti s t h a t r e s i d e s i n t h e c a n a l b e c a u s e o f o v e r l y i n g
t i s s u e . A d d i t i o n a l l y , " g l i d i n g " t e s t e s ( a s d e f i n e d a b o v e )
m a y b e i n t r a -a b d o m i n a l a t t h e t i m e o f a n y g i v e n e x a m i n a -
t i o n a n d h e n c e n o t b e p a l p a b l e ( e v e n t h o u g h c a p a b l e o f
e n t e r i n g t h e c a n a l a n d t h u s p a l p a b l e a t o t h e r ti m e s ) . T h e s e
p a t i e n t s h a v e a p a t e n t p r o c e s s u s v a g i n a l i s a n d a g u b e r n a c -u l u m i s p r e s e n t .
B . I n t r a - a b d o m i n a l t e s t es
1 . C l o s e d r i n g v a r i a n t . I f t h e p r o c e s s u s v a g i n a l i s n e v e r
d e v e l o p s , t h e r e w i l l b e n o g u b e r n a c u l u m . T h e i n t e r n a l i n -
g u in a l r in g i s c lo sed . Th e te s t i s l i e s in t r a - ab d o min a l ly ,
u su a l ly in th e p e lv i s .
2 . O p e n r in g v a r i a n t . T h e s e t e s t es m a y " g l i d e " d o w n i n t ot h e c a n a l , d e p e n d i n g o n t h e l e n g t h o f th e p r o c e s s u s v a g i n -
a l i s . T h e i n t e r n a l r i n g i s o p e n a n d t h e g u b e r n a c u l u m
p a s s e s t h r o u g h t h e r i n g .
7/27/2019 UDT Nomenclature Kaplan
http://slidepdf.com/reader/full/udt-nomenclature-kaplan 3/3
S 1 9 '
C . A b s e n t t e s te s
1 . Agenes i s . I f t h e t e s ti s n e v e r f o r m e d e m b r y o l o g i c a l l y ,
t h e r e s h o u l d b e i p s i l a t e r a l M t ~ l l e r i a n s t r u c t u r e s p r e s e n t .
2 . A t rophic t e s te s , a . M o n o r c h i a . T h e v a s d e f e r e n s a n d
t h e s p e r m a t i c v e s s e l s e n d b l i n d l y o n o n e s i d e.
b . A n o r c h i a . T h e v a s d e f e r e n s a n d v e s s e l s e n d b l i n d l y
b i l a te r a l l y . T h e s e p a t i e n t s s h o u l d h a v e a n e l e v a t e d s e r u m
F S H a n d s e r u m L H a n d l o w s e r u m t e s to s t er o n e .
A d m i t t e d l y , th i s s c h e m e c o m b i n e s o b s e r v a ti o n s o f p h y s i -
c a l e x a m i n a t i o n w i t h s u r g i c a l f i n d i n g s ( w h e n s u r g e r y is
i n d i c a t e d ) . S c h e m a l i m i t e d t o o n l y o p e r a t i v e o r p h y s i c a l
f i n d i n g s to m e s e e m u n w o r k a b l e . T o a v o i d f u r th e r c o n f u -
s i o n an d t o p r o m o t e b e t t e r c o m m u n i c a t i o n , i t s e e m s t h a t
w e m u s t f ir s t a g r e e t o u s e a c o m m o n t e r m i n o l o g y . O n l y
t h e n w i l l w e b e b e t t e r a b l e to a s s e s s c o m p a r a t i v e r e s u l t s o f
e x p e c t a n t , m e d i c a l , a n d s u r g i c a l t h e r a p y .
Re f e r e n c e s
I . A r e y L B ( 1 9 5 4) D e v e l o p m e n t a l A n a t o m y , 6 t h e d . P h i l a d e l -ph ia , W.B. Saunders Co . p 329
2 . Atwel l JD (1985) Ascen t o f the Tes t i s : Fac t o r F ic t ion . Br JU r o l 5 7 : 4 7 4 - 4 7 7
3 . B r e m h o l m - R a s m u s s e n T , I n g e r s l e u H J, H o s t r u p H ( 1 9 88 ) B i -
l a t e r a l S p o n t a n e o u s D e s c e n t o f t h e T e s t i s A f t e r t h e A g e o f 1 0:
Subsequ en t Ef fec t s on Fer t i l i ty . Br J Surg 75 : 820-8 23
4 . I t o H , K a t a u m i Z , Y a n a g i S ( 1 9 86 ) C h a n g e s i n t h e V o l u m e a n d
H i s t o l o g y o f R e t r a c t i l e T e s t e s i n P r e p u b e r t a l B o y s . I n t J A n -
d r o l 9 : 1 6 1 - 1 6 95 . J o s t A ( 1 9 5 3) P r o b l e m s o f F e t a l E n d o c r i n o l o g y : T h e G o n a d a l
a n d H y p o p h y s e a l H o r m o n e s . R e c e n t P r o g H o r m R e s 8 : 3 7 96 . K a p l a n G W ( 1 9 7 6) I a t r o g e n i c C r y p t o r c h i d i s m R e s u l t in g f r o m
H e r n i a R e p a i r S u r g G y n e c o l O b s t e t 1 4 2 : 6 7 17 . K a p l a n G W ( 1 9 90 ) F o l l o w t h e B o u n c i n g B a l l . P e d ia t r i c U r o l -
o g y L e t t e r C l u b .
8 . K a p l a n G W ( 1 9 9 1) N o m e n c l a t u r e o f T e s t i c u l a r P o s i t io n . P r e -
sen ted a t Soc . fo r Ped . Uro l . Annua l Mtg . Toron to , Canada ,June 4, 1991
9 . M o u l J W , B e l m a n A B ( 1 9 88 ) A R e v i e w o f S u r g i c a l T r e a t m e n t
o f U n d e s c e n d e d T e s t e s w i th E m p h a s i s o n A n a t o m i c a l P o s i -t ion . J Uro l 140 :125
10 . Nis ta l M, P an iagua R (1984) In fe r t i l i ty in Ad ul t Males w i thR e t r a c t il e T e s t es . F e r t i l S t e r i l 4 1 : 3 9 5 - 4 0 3
11 . Pur i P , Nixon H R (1977) B i la te ra l Re t rac t i l e Tes tes - Subse -q u e n t E f f e c t s o n F e r t i li t y . J P e d i a t r S n r g 1 2 : 5 6 3 - 5 6 6
1 2. S c o r e r C G , F a r r i n g t o n G H ( 1 9 71 ) C o n g e n i t a l D e f o r m i t i e s o f
t h e T e s t i s a n d E p i d i d y m i s . L o n d o n , B u t t e rw o r t h s .
1 3. W h i t a k e r R H ( 1 9 9 2) U n d e s c e n d e d T e s t e s - T h e N e e d f o r aS tanda rd Class i f i ca t ion . Br J U ro! 70 : t 1 -16
14 . W r igh t JE (1989) Tes tes D o Asc end . Ped ia t r . Surg In t 4 :2 6 9 - 2 7 2
