Incomplete disappearance of the processus vaginalis as a cause of ascending testis

Recently evidence has been accumulating that some undescended testes present later in childhood after apparent normalcy in infancy. These ascending testes appear to explain why a significant number of orchiopexies are performed later in childhood despite the recommendation that surgery for cryptorchidism be performed in infancy. We aimed to determine whether the cause of these ascending testes was persistence of the processus vaginalis.

A total of 25 boys 4 to 13 years old with no history of testicular maldescent at birth underwent transscrotal orchiopexy in a 2-year period. A total of 33 orchiopexies was performed (8 bilateral). The spermatic cord was carefully dissected and operative findings of the nature of the spermatic cord were noted.

In all cases dissection within the spermatic cord revealed a similar finding, namely a fibrous string situated deep to the cremasteric muscle and spermatic fasciae. Transection of this string allowed adequate elongation of the vas deferens and gonadal vessels to permit scrotal placement of the testis. Histological examination revealed characteristic processus vaginalis tissue in which the peritoneal derived mesothelial lining cells were present within a partially obliterated processus vaginalis.

Cryptorchidism presenting later in childhood may be an acquired abnormality caused by failure of natural growth of the spermatic cord when the processus vaginalis leaves a fibrous remnant, which prevents normal elongation. These observations suggest that the ascending testis is acquired postnatally and the cause may be related to inguinal hernia.