A requirement for a priesthood candidate in the Middle Ages was "Duo testes, bene pendulum." Although one could wonder why, considering the goals of celibacy and chastity, this rule attests to the recognition of the importance of descended testes. In John Hunter's early observations and considerations about cryptorchidism in Observation on Certain Parts of the Animal Economy in 1786, he not only noted that testes normally descend during the last 3 mo of gestation but also noted the conundrum that abnormal testes may fail to descend, whereas, conversely, failure to descend may result in abnormal testes.

Currently, the dilemma of whether a cryptorchid testis has an innate defect in addition to potential or actual acquired damage persists, making it difficult to determine ideal therapy. In this chapter, the definition, prevalence, etiologies, natural history, and consequences of testicular maldescent are discussed. Recent data suggest that the major consequences, infertility and malignancy, may not be as prevalent as reported previously, although data must be interpreted with caution, because different populations may have

From: Male Hypogonadism: Basic, Clinical, and Therapeutic Principles Edited by: S. J. Winters © Humana Press Inc., Totowa, NJ

Testostrone Schematic
Fig. 1. Schematic drawing showing the pathway of normal testicular descent into the scrotum and ectopic locations.

been studied. Regarding testicular function, the primary traditional concern continues to relate to spermatogenesis and fertility, although recent data suggest that Leydig cell function may be compromised somewhat as well (1).

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