ANOMALIES OF POSITION OF TILE TESTICLES (Retentio teetis or eryptorchism. Ectopia testis. Inversio tostis) The descent of the testicle, illustrated in Fig. 1S. should be com pleted during the eighth fcetal month. If they are arrested in their progress we speak of a retentio testis, of which there are two degrees: Ai abdominal retention, the cryptorehisni in which the testicles remain within the abdominal pelvis, and (2) the inguinal retention in which they are arrested in the inguinal canal. It is a remarkable fact that the completion of the descent of the testicles may be accomplished even late in childhood. Soltmann observed two cases in which the descent occurred in the ninth, and eleventh years, and Velpeau a case in which it took place in the twenty-second year. In cryptorchisin the testicles can neither be felt in the scrotum, which is somewhat backward in devel opment, nor in the course of the inguinal canal. In "retentio inguinalis," the testicles can be felt in the opening of the inguinal canal, as a stnall oval body-, with its long axis corresponding to the fold of the groin (tioltmann).
The differential diagnosis must be made from a small hernia. Cryptorchism seems to be comparatively frequent in the newborn: among 102 newborn boys, Kiebert observed 30 oases of unilateral or bilateral cryptorchism. Later on the disturbance often is partially relieved, and the percentage becomes smaller (among 10,800 cases it was found 12 times).
Amongst the etiological factors are to be mentioned: abnormalities of the gubernaculum, narrowness of the inguinal canal, intra-abdominal adhesions of the testicle (adhesions of the left testicle to the signioid flexure due to fmtal peritonitis, in one case described by Tandler).
Non-descent of the testicles is of clinical importance because it creates a disposition to inflammatory processes, whose course may be so violent that they remind us of the symptoms of an incarcerated hernia. Cryptorchism is often followed by the appearance of hernire, and it also favors the development of incarceration.
Among the complications must be included: hydrocele, torsion of the spermatic cord, with gangrene of the scrotum. By extension to the cavity of the peritoneum, inflammation of the inguinal canal result ing from trauma may lead to peritonitis. Anaong the sequelie mention must also be made of atrophy of the testicles, and a tendency to malig nant degeneration of the organ. According to Soltniann, atrophy of the testicle is not the immediate result of cry-ptorchism, but is brought about by a chronic inflammation of the testicle, which may be due to trauma front without, or to strangulation from within. In addition to these purely local disturbances there are 11101'0 general symptoms, such as syncope, hystero-epilepsy, which have been referred to this anomaly of position.
By way of treatment, Soltmann recommends that the descent of the testicle be encouraged by massage, and if this is successful, the fixation of the organ by means of proper bandages. Other writers pre fer to operate, freeing the testicle, and anchoring it in its proper posi tion. Sellleau advises that no interference be taken in early infancy, but that massage be used for two to five years, and that operation be postponed till near the age of puberty.
Of lesser clinical importance are the anomalies designated as in versio testis ancl ectopia testis. By inversio testis is understood that condition in which the testicle is rotated upon its own axis; by ectopia testis we mean the condition in which after its passage through the inguinal canal, the testicle is found under the skin of the abdomen, or beneath the crural arch, etc. The most important variety of this ano maly is ectopia perinealis. In this form the testicles lie to the right or left of the median raphe between the anus and the scrotum. They are generally atrophic and movable, but can never be pushed into the scrotum. It is caused by defective size of the scrotal partition. Both inversion and ectopia are often combined with hernia.