Failure of testicular development can occur all along the developmental time line. Early failure results in absence of the testis and the Wolfian structures on that same side. Testosterone must be produced locally to induce development of the vas, epididymis and seminal vesicle on each side. Later failure may result in absence of the testis with presence of a vas.
Diagnosis: When the testis fails to develop, of course, it cannot be palpated on examination. However, the converse is not true; a boy with a non-palpable gonad does not always have failure of testicular development. A testis that does not descend into the patent processus vaginalis in the inguinal canal may not be palpable. In fact, most cases of non-palpable gonad are caused by failure of descent of a developed testis (see III).
Treatment: Once the diagnosis of an absent testis is made no further treatment is necessary. Laparoscopy or inguinal/abdominal exploration are used to confirm that no testis exists. In order to make this diagnosis one must thoroughly examine the retroperitoneum from the internal inguinal ring cephalad to the lower pole of the kidney because the testis may be found anywhere along that tract.
See a case history.
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©David A. Hatch, M.D., 1996