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Testicular Descend, How and Why: A Review Article

Sujan Narayan Agrawal.


Abstract

Background: The testis develops in the dorsal abdominal wall, and then descends to scrotum. The development begins as early as 6th week of intrauterine life and is completed by fifth month of intrauterine life. The testis may get arrested during its descent from dorsal abdominal wall to scrotum. The anomalies of descent includes cryptorchism (and its variant like anarchism, monarchism or partially descended testis), ectopic testis, persistent processus vaginalis and encysted hydrocoel of spermatic cord etc. Cryptorchism is usually diagnosed during the new born examination. The recognition of this condition, identification of associated syndromes, proper diagnostic evaluation and timely treatment by surgical urologist is important to prevent adverse consequences like sterility, congenital hernia & hydrocoel, testicular carcinoma etc.
Objectives: the objective of this review is to study the role of gubernaculum in the testicular migration process.
Material & Method: We performed a descriptive review of the literature about the role of the gubernaculum in testicular migration during the human fetal life. This article provides an overview of role of gubernaculum and other factors responsible for gonadal migration.
Results: In the first phase of testicular migration the gubernaculum enlarges to hold the testis near groin and in the second phase the gubernaculum migrates across the pubic region to reach the scrotum. The proximal end of gubernaculum is attached to the testis and epididymis. The lower end reaches to bottom of scrotum. A failure in the proper functioning of gubernaculum causes cryptorchism. Rarely male gonads may deviate from main pathway due to presence of many tails of distal gubernaculum, and it may give rise to ectopic testis. The processus vaginalis usually closes by birth. If it remains patent, it leads to congenital hernia, hydrocoel, encysted hydrocoel etc.
Conclusion: the gubernaculum presents a significant structure during testicular migration and its failed mechanism gives rise to different pathological conditions.

Key words: Testicular descend, gonads, gubernaculum, processus vaginalis, undescended testis, congenital hernia/hydrocoel






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