Ascending Testis

Ascent during childhood of a previously normally descended testis has been suggested for nearly two decades (101). The ascending testis becomes tethered above the scrotum in an unacceptable position. This may occur consequent to shortening of the processus vaginalis because of inadequate elongation of the spermatic cord (102) or as a complication of inguinal hernia surgery (103). The increased prevalence of cryptorchidism during late childhood than during late infancy and early childhood (4) could also be explained by missed diagnoses in younger boys or by a retractile testes being diagnosed as undescended in older boys. It is widely accepted that testes may ascend from the full scrotal position during mid-childhood years. There are documented cases of boys with undescended testes whose earlier medical records clearly noted descended or retractile testes (104-106). Ascending testis may occur more frequently in boys born with undescended testes who undergo spontaneous descent in early infancy by 3 mo of age (107). The age distribution of orchiopexy is bimodal, with an initial and larger peak within the first 5 yr of life and a second peak in surgical procedures between 8 and 11 yr of age. This distribution could be a consequence of acquired cryptorchidism or ascending testes (108). Ascending testes are believed to be healthy and to have the potential for normal function, although they must be evaluated just like any undescended testis. It has been suggested that retractile testes may retract higher, perhaps becoming ascending testes, with abnormal development (109). In general, ascending testes are viewed as a continuum between retractile testes and more severe forms of testicular maldescent.

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