Congenital Undescended Testis Research Articles

Advocating hormonal treatment to prevent adult in-fertility in patients diagnosed with congenital un-descended testes.

In 2007 the Nordic group came to the following unanimous conclusions: In general, hormonal treatment is not recommended, considering the poor immediate results and the possible long-term adverse effects on spermatogenesis. Thus, surgery is to be preferred. However, defective mini puberty inducing insufficient gonadotropin secretion is one of the most common causes of nonobstructive azoospermia in men suffering from congenital isolated unilateral or bilateral cryptorchidism. The extent of alteration in the unilateral undescended testis correlate with the contralateral descended testis, indicating that unilateral cryptorchidism is a bilateral disease. Idiopathic central hypogonadism explains the phenomenon of defective mini puberty in otherwise healthy cryptorchid boys. We therefore recommend hormonal treatment for cryptorchid boys with defective mini puberty. Gonadotropin releasing hormone agonist (GnRHa) treatment following surgery to correct cryptorchidism restores mini puberty via endocrinological and transcriptional effects and prevents adult infertility in most cases. Several genes are important for central hypogonadotropic hypogonadism in mammals, including many that are transcribed in both the brain and testis. At the molecular level, there is no convincing evidence that heat shock is responsible for the observed pathological testicular changes. Thus, impaired transformation of gonocytes is not the result of temperature stress but rather a hormonal imbalance. Cryptorchidism should therefore be considered a serious andrological problem that cannot be successfully treated by early orchidopexy alone.

Advocating hormonal treatment to prevent adult infertility in patients diagnosed with congenital undescended testes

Advocating hormonal treatment to prevent adult infertility in patients diagnosed with congenital undescended testes

Acquired Undescended Testes: Immediate Surgery or Wait and See?

Undescended testes are a common urological pathology in boys. This condition is categorized according to the examination findings, palpable or non-palpable, and according to the time of diagnosis, congenital or acquired. Orchiopexy is recommended for congenital undescended testes as early as 6 months and up to 18 months at the latest. It is not certain when cases of acquired undescended testes first occur, and most will descend spontaneously into the scrotum. For this reason, when an acquired undescended testis is noticed, the question of whether orchiopexy should be performed immediately or if follow-up is an option becomes important. In this study, we aimed to examine studies on acquired undescended testes in light of the current literature in order to find an answer to this question.

Interplay between collagenase and undescended testes in Adamts16 knockout rats

BackgroundThe inguinoscrotal stage of testicular descent is characterized by an increase in cell density and collagen fibers as the gubernaculum undergoes cell division and increases Extracellular Matrix (ECM) activity. Rats that lack the enzyme Adamts16, a known ECM proteinase, develop cryptorchidism postnatally and are infertile. Therefore, this study aims to investigate the link between the Adamts16 enzyme and congenital undescended testes (UDT) in Adamts16 knockout (KO) rats during postnatal development. MethodsFormalin-fixed specimens of Wild-Type, Adamts16 heterozygous and Adamts16 homozygous KO rats post birth were sectioned and used for standard H&E histology and Masson's trichrome staining. A quantitative analysis on image J was performed to determine the intensity of collagen fibers within the inguinoscrotal fat pad (IFP) (n = 3 age/genotype). ResultsThe migration of the gubernaculum within the Adamts16 heterozygous and Adamts16 KO rat was considerably disrupted. Furthermore, the Masson's trichrome staining demonstrated a significant increase in collagen fibers around the gubernaculum of rats that lacked Adamts16 enzyme at day 8. ConclusionThis study reports a failure of gubernacular migration leading to UDT in Adamts16 KO rats during development, suggesting that the expression of Adamts16 gene is critical for normal gubernacular migration through the breakdown of collagen fibers within the IFP.

Gonocyte transformation in congenital undescended testes: what is the role of inhibin-B in cell death?

Undescended testes (UDT) are subjected to heat stress, which can disturb gonocyte transformation as well as apoptosis. This study aims to describe the apoptosis pathway occurring during minipuberty of children with unilateral (UDT), and to investigate the role of inhibin-B. Testicular biopsies at unilateral orchidopexy of 10 boys (6-9months old) with normal inhibin-B (n = 5) or low inhibin-B (n = 5) were selected for immunohistochemistry and TUNEL (Terminal deoxynucleotidyl transferase dUTP nick end labelling) assay. Testicular tubules were labelled with antibodies against Anti-Müllerian hormone (AMH, Sertoli cell marker), mouse Vasa Homolog (MVH) and placental alkaline phosphatase (PLAP) (both germ cell markers), cleaved caspase3 (apoptotic marker), and followed by confocal imaging and cell counting with Fiji/ImageJ. Data were analyzed with GraphPad Prism. In males with low and normal inhibin-B, there was no statistical difference (p > 0.05) in the percentage of testicular tubules containing TUNEL + cells, number of cleaved caspase3 ± germ cells/tubule, total number of germ cells/tubule, and the percentage of fibrotic tubules or number of Sertoli cells/tubule. These results suggest that inhibin-B does not regulate cell death of gonocytes and further studies are required to uncover any role of inhibin-B in gonocyte transformation.

The impact of primary location and age at orchiopexy on testicular atrophy for congenital undescended testis

In this study, we investigated post-orchiopexy testicular growth of undescended testes (UDTs) at different primary locations and determined the risk factors for testicular atrophy (TA). We conducted a retrospective chart review of boys who had undergone orchiopexy for UDTs during January 2001–December 2013. Patient profile, age at operation, primary UDT location, and testicular volume were noted. TA was defined as ≥50% loss of volume after orchiopexy. The primary endpoints were testicular growth and TA after orchiopexy. The secondary endpoint was risk factors for TA. In total, 182 boys had undergone regular ultrasonography; the median follow-up period was 34 months. Among 230 UDTs, 18 (7.8%) atrophic testicles were identified within a median interval of 13 months after orchiopexy. TA rates were 3.3% (1/30), 6.9% (12/173), and 18.5% (5/27) in primary suprascrotal, canalicular, and above-inguinal UDTs, respectively. The survival probability of UDT was 91%, 92% and 100% when orchiopexy was performed in age ≤1 year, 1 < age ≤2 years, and 100% in age >2 years, respectively. Multivariate analysis revealed that inguinal and above-inguinal UDTs (hazard ratio [HR] 11.76, 95% confidence interval [CI] 1.55–89.33, p = 0.017) and genetic or endocrine disorders (HR 3.19, 95% CI 1.19–8.56, p = 0.021) were the risk factors for TA, but not age at operation, premature birth, and laterality. Thus, TA incidence was higher when patients had high primary testicular locations. Early orchiopexy before two years of age may be associated with higher TA risk, while most testicles have promising growth after orchiopexy.

816 - Testicular atrophy after orchiopexy for congenital undescended testis: Outcomes of testicular survival by different primary locations and ages at orchiopexy

816 - Testicular atrophy after orchiopexy for congenital undescended testis: Outcomes of testicular survival by different primary locations and ages at orchiopexy

Human chorionic gonadotrophin hormone for treatment of congenital undescended testis: Anatomical barriers to its success

Background/PurposeAlthough the surgical treatment was proved to be the recommended line of management for congenital undescended testis, hormonal therapy with human chorionic gonadotrophin hormone has been started long years ago and is still used in some areas with variable degrees of success. The factors responsible for treatment failure are not well explored. In this study, we aimed to highlight the anatomical abnormalities in the congenital undescended testis that might contribute to treatment failure. MethodsDuring the period from January 2014 to December 2015, 75 boys with congenital undescended testes received treatment with human chorionic gonadotrophin, in pediatric surgery department, Faculty of medicine, Ain Shams University. Their age ranged between 6 months and 4 years (mean 1.6 years, median 2 years). In 70 boys, the testes were palpable and in the remaining 5 boys, the testes were impalpable. Fifty boys had unilateral and 25 had bilateral undescended testes. Seven of the palpable testes were high scrotal in position and the remaining 83 were palpated in the inguinal canal. The patients were followed up for 6 months to determine the position of the testis after the treatment and surgical intervention was done for those who did not respond to the hormonal treatment either partially or completely. ResultsOnly 7 testes showed complete descent (7%) (2 bilateral and 3 unilateral) and they were initially high scrotal in position, 8 testes showed partial descent (8%) (2 bilateral and 4 unilateral) and they were inguinal in 6 which became high scrotal and impalpable in 2 which became peeping. The remaining 85 (85%) did not respond to the hormonal treatment. Upon surgical exploration, abnormal attachment of the gubernaculum was found in 83 testes (83%), 2 testes were peeping (2%), short testicular vessels were found in 4 testes (4%), 3 testes were vanishing (3%) and a closed internal ring was found in one testis (1%). ConclusionsTreatment of congenital undescended testis with human chorionic gonadotrophin hormone had low success rates. Anatomical abnormalities in the congenital undescended testis might contribute to this treatment failure. Type of the studyClinical research paper. Level of evidencelevel III.

Secular trends in the incidence and timing of surgical intervention for congenital undescended testis and surgically treated hypospadias in Ontario, Canada between 1997 and 2007

Recent studies have suggested contradictory trends in the incidence of undescended testis (UDT) and hypospadias (HYP), partly because of methodological issues and ascertainment bias. The recently described association of "testicular dysgenesis syndrome" links concomitant UDT and HYP, with decreasing sperm counts and testicular cancer. Current guidelines suggest that orchidopexy for UDT should be performed by 18 months of age. We conducted a retrospective population-based cohort study to estimate the incidence of UDT, HYP, and concomitant UDT and HYP in Ontario, based on a surgical procedure performed in the 5 years after birth. We hypothesized that the incidence of UDT and HYP are stable in the province of Ontario, Canada, over an 11-year time period. Linked administrative databases held at the Institute of Clinical Evaluative Sciences (ICES) in the province of Ontario, were used to identify all live male newborns between 1997 and 2007. Incidence rates of UDT, HYP and concomitant UDT and HYP were calculated by identifying a surgical procedure for these anomalies, within 5 years of birth. Incidence trends were analyzed using the Cochrane Armitage test for trend. Age at surgery for surgical intervention for an orchidopexy or HYP repair was determined. The incidence of UDT, defined by an orchidopexy within 5 years of birth, has remained stable in Ontario, Canada (8.2/1000 male live births, p-value for trend 0.9, 95% CI 8.0-8.4). The incidence of hypospadias has similarly remained stable (3.8/1000 male live births, p-value for trend 0.8, 95% CI 3.7-3.9). The incidence of concomitant UDT and HYP repair showed a significant increase over the 11-year period (0.2/1000 male live births, p-value for trend 0.03, 95% CI 0.2-0.3). The median age at orchidopexy (23 months, IQR 16-34 months) was beyond guideline recommendations, with earlier orchidopexy in recent years. The median age at hypospadias repair was 17 months (IQR 12-26 months). The variable rates of incidence for UDT and HYP can be explained by variations in study methodology and differing data sources utilized. The current study uses a surgical procedure to minimize information bias to correctly identify index cases of UDT and HYP. The incidence of undescended testis and hypospadias, over 5 years after birth, has remained stable in the province of Ontario between 1997 and 2007 (Summary Table). Concomitant UDT and HYP incidence showed a significant increase over this time period. Most boys in Ontario, Canada, undergo orchidopexy beyond 18 months of age.

Guideline implementation for the treatment of undescended testes: Still room for improvement

BackgroundEarly orchidopexy (OP) around the age of 1 year is recommended in boys with congenital undescended testis (UDT) worldwide since decades. Former retrospectives studies did not distinguish congenital from acquired UDT with a consecutive negative bias concerning the age at surgery. MethodsIn a retrospective analysis, data of all boys who underwent OP in eight pediatric surgery institutions from 2009 to 2015 were analyzed. Congenital or acquired UDT were differentiated. Patients were categorized into 3 groups of age at surgery: (1) <12 months, (2) 12–24 months, (3) >24 months. Data of one institution were analyzed in detail: exact age of first referral, exact age at surgery, intraoperative findings. ResultsOut of 4448 boys, 3270 boys had congenital UDT. In 81% (2656 cases) surgery was performed beyond the age of 1 year, in 54.4% (1780) beyond the age of 2 years. chi-Square statistics showed a higher rate of early operations in hospitals compared to outpatient services and in Germany compared to Switzerland. In 694 congenital detailed cases, median age at referral was 13 months [range 0–196], median age at surgery was 15 months [range 0–202]. ConclusionDelayed referral is the main reason for guideline non-conform delayed surgery in UDT. Type of StudyClinical Research paper. Level of evidenceLevel III: Treatment Study.

The Role of the Appendix Testis in Normal Testicular Descent: Is There a Connection?

Objective The presence of testicular appendices was prospectively evaluated in 89 boys with 96 undescended testes who underwent orchidopexy over the period of 4 years. Results The patients were divided into two groups. Group A included 42 boys with 49 undescended testes positioned close to the internal inguinal ring, and Group B included 47 boys with 47 undescended testes close to the external inguinal ring. The incidence of appendix testis (AT) in Group A was 57.1% (28 in 49) and 78.7% (37 in 47) in Group B. The results of our study showed significantly decreased incidence of testicular appendices in undescended testes positioned close to the internal inguinal ring compared with undescended testes positioned close to the external inguinal ring (p < 0.05). Conclusion AT may play a role in normal testicular descent and the undescended testis positioned close to the external inguinal ring can be considered as a separate entity of the true congenital undescended testis.

Gonocyte transformation in a congenitally cryptorchid rat is normal and may be similar to the situation reported in human acquired cryptorchidism

BackgroundIn congenital undescended testis (UDT) in humans, thermal insult damages early germ cell development during mini-puberty (3–6months) causing increased risk of both cancer and infertility. In rodents however, UDT causes infertility but not cancer. In the TS rat with congenital UDT we hypothesized that early germ cell development would be normal as UDT only becomes manifest at 3–4weeks (and the germ cells only become sensitive to thermal injury) after minipuberty is complete at 1week. MethodsNormal testis and potential UDT from unilateral cryptorchid TS rats were collected at week 1 and 4 and processed into paraffin sections labeled for Sertoli cells (AMH), early germ cells (MVH) and spermatogonial stem cells (PLZF). Confocal microscopic images and Fiji Image J were used to count cells in testicular tubules with paired T-test statistical analysis. ResultsTotal germ cells/tubule, basement membrane-bound germ cells/tubule, and Sertoli cells/tubule were unchanged between normally descending and future UDT at 1–4weeks old (P>0.05) Total germ cells/tubule and spermatogonial stem cells/tubule increased dramatically between weeks 1 and 4. ConclusionRat gonocyte transformation is normal in both normally descending and future UDT. This suggests that congenitally cryptorchid rats may not develop testicular cancer because gonocytes (the putative origin of malignant degeneration) normally transform into spermatogonial stem cells before UDT occurs and the risk of thermal injury develops. This suggests the TS rat may be a good model for acquired UDT in human where the abnormal testicular position develops after gonocyte transformation is completed in the first year.

Undescended testis: What paediatricians need to know.

Undescended testis (UDT) occurs when something goes wrong with testicular descent from high in the abdominal cavity to the scrotum. Normal descent occurs in two steps, with the transabdominal phase controlled by a new testicular hormone, insulin-like hormone 3, and the inguinoscrotal phase controlled by androgens. The latter phase requires a complex process of migration from the inguinal abdominal wall to the scrotum and is commonly defective, leading to the high incidence (2-4%) of UDT at birth. The clinical examination of babies and infants aims to confirm the persistence of congenital UDT by 3-6 months, so surgery can be optimally timed at 6-12 months. For those boys who develop acquired UDT later in childhood, the 'ascending' testis often needs surgery between 5 years and 10 years, so all boys should be screened again for UDT at school entry.

Frequency of revision orchidopexy in Australia 1995–2014

Background/aimInternational criteria currently suggest orchidopexy at 6–12months for congenital undescended testis (UDT). Some children require repeat orchidopexy for recurrent UDT. This study aimed to assess practice in Australia over a 20-year period. MethodsWe examined 20years of Australian orchidopexy data (1995–2014) from the Department of Human Services to explore the national revision orchidopexy rates over time. ResultsThe total number of orchidopexy revisions was 890 over 20years compared with 25,984 primary operations. More than 50% of all primary and revision orchidopexies in 0–14year-old boys were performed in major population centers of NSW and Victoria (which hold 52% male population of same age), with a small number of revisions on 15–24year-old males. The incidence of revision orchidopexy significantly decreased over the 20-year period in boys ages 0–14years old, from 276 operations between 1995 and 1999 decreasing to 165 operations between 2010 and 2014 (−53%), compared to a population increase of +15% (p<0.05). ConclusionThese data demonstrate a decrease in revision orchidopexy since 1995, which may be related to change in referral practice with more children undergoing orchidopexy (primary and revision) by pediatric surgeons over the 20-year period. Level of evidenceLevel IV. Type of StudyTherapeutic Case Series with no Comparison Group.

Prevalence and Chronological Changes of Testicular Microlithiasis in Isolated Congenital Undescended Testes Operated On at Less Than 3 Years of Age

To clarify the prevalence and chronological changes of testicular microlithiasis in isolated congenital undescended testes, retrospective chart review was performed. Among children with palpable isolated undescended testes who underwent orchiopexy at less than 3 years of age between January 2009 and May 2016, those who had preoperative testicular ultrasonography were enrolled. Testicular microlithiasis was classified as limited or classic. Sixty-five patients (54 unilateral undescended testes and 11 bilateral undescended testes) were enrolled. Preoperative evaluation demonstrated limited testicular microlithiasis in only 2 undescended testes in 2 patients (1 with unilateral undescended testes and 1 with bilateral undescended testes). Of these patients, 1 with unilateral undescended testes had limited testicular microlithiasis and the other with bilateral undescended testes had classic testicular microlithiasis after surgery. Among 53 unilateral undescended testes without microlithiasis preoperatively, limited and classic testicular microlithiasis was found in 1 and 6 testes, respectively, during follow-up. Testicular microlithiasis was identified in 2 on the contralateral descended testis of unilateral undescended testes postoperatively. Among 10 patients with bilateral undescended testes without microlithiasis preoperatively, limited testicular microlithiasis was detected in 4 during follow-up. Testicular microlithiasis was not diminished or resolved during follow-up. The overall prevalence of testicular microlithiasis in undescended testes (21.1%) was significantly higher than that in the contralateral descended testis in patients with unilateral undescended testes (3.7%) (P < .01). Most testicular microlithiasis was identified postoperatively and never improved. The prevalence of testicular microlithiasis in isolated congenital undescended testes increased with time even if operated on early in life.

INSL3 and AMH in patients with previously congenital or acquired undescended testes

BackgroundIn previous reports no differences in Leydig and Sertoli cell function were found between congenital undescended testis (CUDT) and acquired UDT (AUDT) on the basis of serum levels of LH, testosterone, FSH or inhibin B. This study tried to detect differences in Leydig and Sertoli cell function between CUDT and AUDT using insulin-like peptide 3 (INSL3) and anti-Müllerian hormone (AMH). Method118 men with a history of UDT (CUDT N=55 (6/55 bilateral), AUDT N=63 (15/63 bilateral)) were investigated. Differences between CUDT and AUDT, influence of age at surgery in CUDT, and effect of spontaneous descent or orchiopexy in AUDT were evaluated. ResultsFor INSL3, no significant differences were found. AMH levels in bilateral CUDT were significantly lower compared with bilateral AUDT (6.4 (1.7–11.4) vs 13.2 (6.1–30.1) μg/l, p=0.02). AMH levels in unilateral CUDT were significantly higher than in bilateral CUDT (12.1 (2.4–43.7) vs. 6.4 (1.7–11.4) μg/l, p=0.02). ConclusionNo differences in Leydig cell function on the basis of INSL3 levels between the different UDT groups were found. Sertoli cell function evaluated by AMH, was more negatively affected in bilateral CUDT in comparison with bilateral AUDT and unilateral CUDT. Level of evidence ratingLevel III Treatment Study.

Acquired cryptorchidism: More harm than thought?

Acquired cryptorchidism (AC) has been recognized as a subgroup of undescended testes (UDT). There is growing evidence that the compromising effect equals that of congenital UDT (cUDT). This prospective study included an extensive histological examination of biopsies taken from AC patients. From August 2013 to December 2014, 21 boys (3-12 years of age) underwent testicular biopsy during orchiopexy for AC. Patient and family histories were taken. The amount of germ cells (GC) per tubule (T) and the amount of adult dark spermatogonia (Ad-S) per T were determined by resin semi-thin sections examination. The samples were also scanned for signs of malformation. Immunohistochemical stains were performed as markers for atypical germ cells. Four (19%) boys were born prematurely, two (9.5%) were small for gestational age (SGA), and nine (43%) had a positive family history of UDT. The median of GC/T was 1.06 in boys <9 years, and 0.60 in boys ≥9 years. The median of Ad-S/T was 0.02 in boys <9 years and 0.01 in boys ≥9 years. There were no signs for malformation and no atypical cells. The immunohistochemical stains were negative in all specimens. Prematurity, SGA, and a positive family history appeared to be predictors for AC. Extensive histopathological examination of AC revealed a significant reduction of germ cell count and fertility markers, comparable with that in cUDT. The alterations were more severe in boys aged ≥9 years. It is unclear as to whether or not this was possibly caused by a longer duration of inguinal position, but this finding suggests that routine checks of testicular position throughout childhood are needed, and that there is a cause for continued efforts in educating parents and primary care physicians regarding AC. Current data support the notion of surgical correction once the diagnosis is made.

VARIATIONS IN TIMING OF ELECTIVE ORCHIDOPEXY.

Undescended testis or cryptorchidism is detected in 3% of full-term male newborns, and inup to 33% of preemies. As the testicular descent may sometimes resolve spontaneously during first months of life, cryptorchidism is found in 1% of boys one year old. According to Consensus of Nordic experts in. pediatric urology regarding cryptorchidism the optimal period for surgery is 12-18 months of age. The goal of this study was to identify the age of patients with congenital undescended testis at the time of surgery. A retrospective study included all the cases of cryptorchid patients who had undergone orchidopexy in the period from 2007 to 2014. The patients'. age and the place of residence were analyzed. A total of 637 patients (722 orchidopexies) underwent the elective operative treatment of undescended testis during the observed period. The analysis revealed that only 144 (22.60%) of cryptorchid infants were operated on within their first 18 months of life. In the group of 359 patients from* the urban environment, 101 (28.13%) were operated under the age of 18 months. Among the 278 patients from the rural enviornment, 43 (15.46%) were 18 months and younger at the time of surgery. The timing of surgical treatment of undescended testis in the study period was far from the recommended optimal time. It is evidently necessary to plan and provide additional information for pediatricians and parents about the current view on cryptorchidism and consequences of the late treatment.

Evaluation and management of the infant with cryptorchidism.

Normal testicular descent is now recognized to occur in two steps with the first, transabdominal stage controlled by insulin-like hormone 3. The second, inguinoscrotal stage is controlled by androgens, mostly indirectly via the genitofemoral nerve, which appears to direct the migration of the gubernaculum to the scrotum. Undescended testis (UDT) is multifactorial, with only some of the genes identified. This review highlights recent developments that are leading to changes in practice. There is an emerging consensus among pediatric surgeons and urologists about the management of UDT with recommendations that the diagnosis of congenital UDT should be confirmed at 3-6 months of age and orchidopexy done at 6-12 months of age. With the recommendations for early surgery, recent studies focus on the complications of orchidopexy, to determine whether this is higher in infants than older children. In addition, there is general acceptance of the existence of 'acquired' UDT, which develops after about 2 years of age, but treatment for this group remains controversial. Evaluation of children with UDT now needs to be separated into the assessment of possible congenital UDT in infants at 0-6 months, for orchidopexy before 12 months, and preschool boys, who may be developing acquired UDT.

Scrotal ultrasound findings in previously congenital and acquired unilateral undescended testes and their contralateral normally descended testis.

The aim of this study was to report on different anomalies found by physical examination and scrotal ultrasound in men with previously unilateral congenital undescended testes (UDT; N=50), acquired UDT (N=49), their contralateral normally descended testis (CNDT) and control testes (N=53). Acquired UDT significantly more often had a testicular volume being <15mL than congenital UDT (88% vs. 68%). In the congenital group, significant differences were found between UDT and CNDT for soft consistency (UDT 36% vs. CNDT 14%), epididymal diameter (UDT 7.6mm vs. CNDT 8.9mm), testicular volume (UDT 9.8mL vs. CNDT 13.8mL), and inhomogeneous parenchyma (UDT 38% vs. CNDT 14%). In the acquired group, significant differences were found between UDT and CNDT for epididymal diameter (UDT 7.5mm vs. CNDT 8mm), testicular volume (UDT 9.3mL vs. CNDT 14.1mL), testicular volume <15mL (UDT 88% vs. CNDT 59%), and inhomogeneous parenchyma (UDT 27% vs. CNDT 6%). The following parameters of congenital UDT, acquired UDT, congenital CNDT, and/or acquired CNDT significantly differed compared with controls: soft testicular consistency (congenital UDT 36%, acquired UDT 20%, congenital CNDT 14%, acquired CNDT 12% vs. controls 0%), epididymal diameter (congenital UDT 7.6mm, acquired UDT 7.5mm, acquired CNDT 8mm vs. controls 9.2mm), testicular volume (congenital UDT 9.8mL, acquired UDT 9.3mL, congenital CNDT 13.8mL, acquired CNDT 14.1mL vs. control testes 15.8mL), testicular volume <15mL (congenital UDT 68%, acquired UDT 88%, congenital CNDT 66% vs. controls 43%), inhomogeneous parenchyma (congenital UDT 38%, acquired UDT 27%, congenital CNDT 14% vs. controls 0%), and testicular microlithiasis (congenital CNDT 24% vs. control testes 8%). Few differences between congenital and acquired unilateral UDT and congenital and acquired CNDT support the hypothesis of a spectrum of maldescended testes containing congenital and acquired UDT instead of them being two different entities. The CNDT also has anomalies albeit less severe than the UDT, indicating that in unilateral UDT both testes are affected.