UNDESCENDED TESTICLE.—The testi cle may be arrested in any parts of its course in its descent from the kidney to the scrotum; when retained in the ab domen, it is termed cryptorchidism. It is sometimes found in the groin and in the perineum. The cause of these ab normalities has been variously attributed to small rings, a short cord, peritoneal adhesions, and loss of power or anomalous attachments of the gubernaculum.
Misplaced testicles, as a rule, are un dersized, and there is a degeneration and atrophy of the secreting structure. They are often functionless, and sterility re sults. In some of the reported cases sper matozoa were found. When misplaced outside of the abdomen, the testicles are exceedingly liable to injury, and inflam mations and malignant degeneration are common.
Diagnosis.—When the testicle is re tained in the inguinal canal it must be distinguished from hernia, which can usually easily be done by noting the ab sence of the testicle from the scrotum, ovoid shape, irreducibility, and the sick ening pain when pressed upon. When situated in the region of the groin, it may be confused with bubo, especially when orchitis is present. The same rules. however, hold good as in the case of hernia.
Treatment —When the organ still re mains in the abdomen, nothing can be done by surgical intervention; its attach ments, being necessarily short, would prevent its being dragged down into the scrotum. When situated in the inguinal canal, an effort should be made to bring it into the scrotum by daily traction, its return into the canal being prevented by the use of a truss having a very soft pad.
If it cannot be drawn down into the scro tum by the sixth year, operation is neces sary (orchidopexy). The gland is ex posed by a free incision, and brought out of the wound, so that the fibres of the cremaster may be divided transversely. The cord is then gently stretched until the testicle hangs free beyond the exter nal abdominal ring. The scrotum is now invaginated and fastened to the base of the testicle by three catgut or silk sutures. When the invaginated scrotum is drawn out, the anchored testicle is carried into its proper place. The deeper tissues are closed by catgut, and the tis sues of the cord are sutured to the pil lars of the external ring.
In the femoral variety of misplace ment, the testicle should be returned to the abdominal cavity and held in place by a truss. In the perineal form, the operation for inguinal displacement can occasionally be carried out. When situ ated near the internal ring, it should be protected from injury by the use of an appropriate pad or truss.
When seen late in life, castration is al ways advisable, as the organ is probably functionally useless, and is liable to sar comatous degeneration.