Hypospadias, cryptorchidism and common male genital disorders: Viva

Branch 1: Confirming the diagnosis and separating the mimics

The candidate should state that the diagnosis of cryptorchidism is clinical and rests on a careful examination of the warm, relaxed child in the frog-leg or cross-legged squatting position, which relaxes the cremaster. ^[11] The examiner milks the testis down from the inguinal canal with one hand and palpates with the other, and a testis that can be brought into the scrotum but springs straight back out, or that cannot be brought down at all, is a true undescended testis. The stimulus case, in which the testis is palpable in the canal but cannot be brought to the scrotum, is a palpable undescended testis. ^[1]

If the examiner presses on the mimics, the candidate must distinguish the retractile testis, the ectopic testis, and the vanishing testis. The retractile testis is a normally descended testis pulled up by a brisk cremasteric reflex, and the defining test is that once milked into the scrotum it stays there without tension; this is a normal variant that needs follow-up rather than surgery. ^[11] The ectopic testis has descended through the external ring but come to rest in an abnormal location, and the vanishing testis is the result of prenatal vascular infarction. The retractile testis must be followed annually because up to a third ascend to become an acquired undescended testis. ^[11]