Retention occurs in various forms, according to whether the testicle is retained in the abdominal cavity (cryptorchism) or in the inguinal canal. Ectopia includes abnormal displacement in the crural canal or in the perincal tissue (cctopitt cruralis or perinealis).
The causes are probably always disturbances of development on a biological basis, as previously described. All other explanations, such as inflammatory processes and occlusions, are hypothetical.
The symptoms manifest themselves externally by absence of the testicles from the scrotum.
It has often been observed that in a large number of newborn the inguinal canal remains permeable for the testes for a considerable time. Under the influence of cold or of the cremaster reflex (stroking the inner surface of the thigh) the testicle, being situated in the inguinal canal, may retract into the abdominal cavity and reappear as soon as the external stimulus ceases.
A pathognomonie sign in all these children is an unusual smallness of the scrotum, but this is probably secondary and not an etiological manifestation. In all these children, too, the processes vaginalis is open. In many cases I was able to arrive at this conclusion from the palpable thickness of the seminal cord; in others proof was furnished later by the development of a hernia. The position of the testicle can always be established by careful examination of the inguinal canal and its vicinity, the painfulness of the little tumor serving as a sure guide.
Subjective symptoms will only manifest themselves in the event of incarcerations in the muscular apparatus of the inguinal canal which may lead to severe symptoms, such as vomiting, nausea, or pains in the inguinal region (pseudo-appendicitis).
Prognosis.—Attention to the conditions arising from the history of development as well as observation of a large number of such eases has demonstrated that the testicle, as it increases in weight, may in the further course of development spontaneously find its physiological posi tion. Should it remain at its abnormal place owing to shortness of the accompanying tissues, its further growth seems to he interfered with; but in unilateral arrest of descent compensation nearly always occurs by increased growth of the other testicle. Frequent irritations and incarcerations are no doubt a fruitful source of pathological new growths in the region of the retained or ectopic testicle.
anomaly should be corrected if it causes sub jective complaints. No treatment is necessary if the testicle lies either completely in the abdominal cavity or above the inguinal canal, so that none but inguinal testicles demand interference. Attempts have been made to effect an elongation of the seminal cord by bifurcated pads and massage manipulations and in this way to cause a normal localization of the testicle (Sebillau and Goltmann). But mechanical irritation of this kind should, of course, be discarded in the treatment of children.
truss to prevent prolapse into the inguinal canal reduces the patient to the condition of a cripple without absolutely preventing occasional incarceration. These considerations lead to two principles of treatment, viz.: 1. Ectopia causing no visible complaints should be left untreated.
2. In the event of pain or of a visible hernia radical operation is indicated.
In all cases of inguinal testicle we have operated upon, there was also a congenital hernial sae, which can be explained by the history of development. The hernial sac was isolated, incised in the middle, the upper part cared for after Kocher's method, and the lower part adherent to the testicle was used to anchor the testicle by the fan method to the bottom of the scrotum or at the septum, or at least as far down as the shortness of the cord structures would permit without causing undue tension.
1 prefer this method to all others, because the tissue of the testicle remains untouched and its motility is not greatly disturbed. The outer inguinal ring should be sufficiently narrowed to prevent the testicle from sliding back.
Suturing the testicle itself should only be considered in the absence of an available hernial sac (Orchidopexy, after Kocher, Nicoladoni, Lotheisen, Broca). Mauclair's method to suture the ectopic testicle to the healthy one, or to suture both cctopic testicles together, is in my opinion not physiological.
A testicle which cannot, be moved to a position in front of the ingui nal canal is best placed in the abdominal cavity and the inguinal canal closed.
Castration in children is certainly inadmissible.