52. Congenital abnormalities and infammatory diseases of the testes. Pathology of the appendices of the testis (epidydimis, spermatic cord)

Page created on April 21, 2019. Last updated on May 4, 2019 at 12:22

Congenital abnormalities of the testes

The testes develop in the retroperitoneum and descend through the abdominal cavity and the inguinal canal into the scrotum. The descent into the pelvis usually occurs within month 3 of intrauterine life while the descent through the inguinal canal and into the scrotum occurs during the last 2 months. It’s not uncommon that the last step occurs during the first months of life.

Cryptorchidism is the most common abnormality here. It involves incomplete descent of one or both testicles into the scrotum. As some testes don’t physiologically descend until sometime after birth, the diagnosis of cryptorchidism is definite only if the testes still haven’t descended 1 year after birth. Cryptorchidism affects 1% of the male population, and around 10% of affected people are affected bilaterally.

The risk is higher in preterm infants. Undescended testes undergo atrophy, so bilateral cryptorchidism causes sterility. Cryptorchidism increases the risk of testicular cancer 3 – 5-fold. In unilateral cryptorchidism this increased risk affects the descended testicle as well, suggesting an intrinsic abnormality of the testes. Most cases resolve spontaneously by the age of two. For those that don’t; the surgical treatment for cryptorchidism is called orchidopexy.

Other congenital abnormalities of the testes include:

• Anorchidism – absence of both testes
• Monorchidism – absence of one testis
• Microorchidism – abnormally small testes
• Macroorhidism – abnormally large testes
• Polyorchidism – more than two testes
• Ectopic testes – testes that have deviated from the normal path of descent and settles in unexpected locations
• Ectopic adrenal tissue in testes
• Splenogonadal fusion – fusion of the spleen and a gonad

Inflammation of the epididymis and testes

Epididymitis is more frequent than orchitis, and the latter usually occurs as a complication of the former, in which case the condition may be called epididymo-orchitis.

Epididymitis most frequently occurs due to urinary tract infections and sexually transmitted infections like E. coli, Chlamydia trachomatis and Neisseria gonorrhoeae. The most common symptom is scrotal pain. Bacterial epididymitis may lead to bacterial orchitis.

Bacterial orchitis causes enlargement and tenderness of the affected testis. Potential complications include testicular abscess or even testicular infarct.

Viral orchitis is often caused by the mumps virus. It may lead to sterility.

Chronic epididymitis and orchitis may be caused by post-primary tuberculosis.