Diagnosis and Treatment of Crossed Testicular Ectopia

Crossed Testicular Ectopia (CTE), an extremely rare congenital anomaly, was first described by Lenhossek, the finding of an ectopic testis in an autopsy performed by his father (1). It is a deviation of testicular descent resulting in unilateral location of both testes (2). CTE poses a problem of diagnosis and treatment. The ethology of crossed testicular ectopic remains undefined but has been speculated to result from abnormal inguinoscrotal descent of ectopic testes (3). Between Jan 2005 and Dec 2013, 11 boys were treated for CTE in the department of Pediatric Surgery in Hedi Chaker Hospital in Sfax. Patient demographics, clinical data, operating techniques and intraoperative findings were collected and analyzed. The age of the patients ranged from 10 to 15 mo (average 11.7 mo). Diagnosis of CTE had been made in 7 cases of the eleven 64% in intraoperative (Fig. 1): Two cases in strangulated inguinal hernia 18%, four cases had bilateral undescended testes which are not palpable 36% and five boys had inguinal hernia with contralateral undescended testicle 45%. For the four patients who had bilateral undescended testes that are not palpable, ultrasound exploration was made in preoperative confirming the diagnosis of CTE. The age of operation was between 12 and 18 mo. A trans-septal orchiopexy was performed via the inguinal incision after determination of adequate length of the spermatic cord in all patients (Fig. 2). A persistent Mullerian duct syndrome was objectified in 6 cases 54.5%: 3 patients from how had bilateral undescended testes which are not palpable and 3 patients from how had inguinal hernia with contralateral undescended testicle. The mean follow-up was 2.6 yr (range 2-10 yr), 3 patients 27% presents a contralateral testicular atrophy.