Is the ascending testis actually ?stationary?? Normal elongation of the spermatic cord is prevented by a fibrous remnant of the processus vaginalis

Abstract

The processus vaginalis (PV) forms as a peritoneal diverticulum within the gubernaculum testis to allow the testis to exit from the abdominal cavity. Failure of its closure leads to inguinal hernias and hydroceles. Ascending testis, which is likely to be an acquired form of undescended testis, may also be part of the spectrum of failure of regression of the PV. At orchidopexy for cryptorchidism in older boys with a history of a scrotal testis in infancy, we find that the PV persists as a fibrous string, preventing normal elongation of the vas deferens and gonadal vessels with increasing size of the boy. We propose that the ascending testis is actually 'stationary', and is caused by persistence of a fibrous remnant of the PV. Seen in this light, ascending testes are directly related to inguinal hernias.