Time of testicular.descent:

• 3rd month of foetal life — iliac fossa.
• 7th month of foetal life deep inguinal ring.
• Later part of 7th  month of foetal life — traveling down the inguinal canal.
• 8th month of foetal life-superficial inguinal ring.
• By 9th month i.e. shortly before or at birth-drops into the scrotum, i.e. the final seat of destination.

Factors helping the descent of testis:

1. Shortening of and traction of the gubernaculums testis.
2. Differential growth of the body wall in relation to relatively immobile gubernaculums.
3. Raised intra-abdominal pressure due to foetal accumulation & relative growth of the abdominal viscera pushing the testis through the inguinal canal that is engorged by the swollen gubernaculums.
4. Development & maturation of the epididymis inducing testicular descent.
5. Hormonal factors- supposed to play the major role in promoting testicular descent. The hormones are hCG from maternal circulation, testosterone & dihydrotestosterone from the testes.

UNDESCENDED TESTES/ECTOPIC TESTES

Undescended testes: 

The testes lies in sites other than normal site. When testes cannot be found in scrotum, 3 possibilities should be considered

1) Ectopic testes (common): The testes is abnormally placed outside its normal path such as –

• At the superficial inguinal ring
• In the perineum
• At the root of the penis.
• In the femoral triangle

2) Incompletely descended testes (uncommon); The testes is arrested in some part of its path to thescrotum. The testis may be

• Intra-abdominal.
• Intracanalicular
• Extracanalicular. 
• Ectopic.

What is cryptorchidism?

Cryptorchidism:  Bilateral undescended testes which are clinically impalpable are called cryptorchidism. In this condition the testes is in the inguinal canal.

Diagnosis & treatment of undescended testes.

Clinical features:

1) It is unilateral on the right side in 50% and on the left in 30%

2) Arrested descent of both testes occurs in 20%

3) Secondary sexual characteristics are normal but other abnormalities of the genitourinary tract may be present.

4) The testis may be

• Intra-abdominal, lying extraperitoneally, usually just above the internal inguinal ring.
• In the inguinal canal, where it may or may not be palpable (When both testes are impalpable in the scrota, the condition is known as cryptorchidism (Hidden testes).
• In the superficial inguinal pouch.

Treatment of undescended testes:

Orchidopexy (orchiopexy) :  performed within 2-7 years of age : 

• Mobilization of the testis and spermatic cord.
• Retaining the testis in the scrotal septum (Ombredanne’s operation).

> In failure to bring the testis down:

The testis is mobilized as far as possible and anchored with a suture

The mobilization is completed 6 months later.

Orchidectomy :

should be considered if the other testis is normal, especially if the incompletely descended testis is hopelessly atrophic or the patient is past puberty.

> Hormone treatment with HCG (human chorionic gonadotrophin) is only appropriate when there is established hypogonadism.

Hazards/complications of an undescended (incomplete descent) testis:

1. Infertility.
2. Malignancy: Seminoma.
3. Hernia: An associated indirect inguinal hernia is often present.
4. Testicular torsion.
5. Epididyme-orchitis

Differential diagnoses of groin pain:

This is a very difficult areas to assess as referred pain to the groin cam come from many sources. These include :

1. Ureteric colic.
2. The hip (labral tears, and osteoarthritis)
3. Adductor tendon injuries.
4. Stress fractures of the femur, pubis or stress fractures of the femoral neck.
5. Hernias (these may be small and include femoral and obturator hernias).
6. Tumours
7. Sexually transmitted diseases.
8. Gynaecological and urinary problems.
9. Referred pain from the lumbar spine.