UNDESCENDED TESTES REMAIN A DILEMMA DESPITE RECENT ADVANCES IN RESEARCH

Abstract

[Extract] Opinions regarding the best treatment for undescended testes have turned nearly a complete circle in the past century, from surgery to hormone therapy and very recently back in favour of surgery. Testicular descent has evaded full elucidation, although our understanding is vastly more sophisticated than in the 1880s, even though current explanations embody many of the old theories. Many old mechanical ideas have been rehabilitated recently to fit the new paradigms, Moreover, some powerful and alluring concepts, such as hormone treatment of cryptorchidism, are in retreat. Many dilemmas and controversies remain in both clinical and laboratory work. Hormones mediate testicular descent, but the causes of undescended testis are not necessarily hormonal. The clinical diagnosis of undescended testes is confused by so-called 'retractile' and 'ascending' testes. The best timing of surgery or hormonal therapy is still debated, and the long-term results on fertility and testicular malignancy remain unclear. Nevertheless, recent advances in laboratory, clinical and epidemiological research are completely reshaping our notions of normal and abnormal descent of the testis, and soon should help resolve these controversies.