Clinical significances of abnormal gubernaculum testis in cryptorchidism

Objective To discuss the clinical significances of abnormal gubernaculum testis.Methods A total of 169 patients with cryptorchidism who underwent surgical correction from January 1994 to December 2003 were included.The positions of cryptorchids,lengths and attaching locations of gubernaculum testis were directly observed and recorded during operation.Results In 212 cryptorchids of the 169 patients with cryptorchidism,there were 42(19.8%) abdominal testes,134(63.2%) inguinal canal testes,and 36(17%) upper scrotal testes.The gubernaculum was attached around the inguinal canal ring,the upper scrotum and other locations in 73.8%(31),21.4%(9) and 4.8%(2) of the abdominal testes.The gubernaculum was attached around the inguinal ring in 87 inguinal canal testes(64.9%),to the upper scrotum in 35(26.1%) and to the bottom of the scrotum in 9(6.7%).In cases of the upper scrotal testes,the gubernaculum was attached around the inguinal ring in 25%(9),to the upper scrotum in 52.8%(35) and to the bottom of scrotum in 22.2%(8).The average length of gubernaculum testes in abdomen,inguinal canal and upper scrotum was(3.1±1.1)cm,(3.2±0.7)cm and(2.5±0.4)cm,respectively.The average length of gubernaculum testes in the upper scrotum was significantly shorter than that of the other 2 types(P0.01).Conclusions Gubernaculum testis has a role in guiding and drawing the testis into inguinal canal and scrotum.As most abnormal gubernacula of cryptorchid testes are associated with transferring stop or undegrading or abnormal attachment,it is very difficult for hormonal therapy to change these anatomic abnormities,which may be the reason that it needs surgical correction when hormonal therapy fails to obtain effects in cryptorchidism.In addition,as gubernacular vessels provide blood for cryptorchid testis,orchiopexy reserving gubernaculum testis has important value to cryptorchid testis with poor blood supply in spermatic cord and impalpable abdominal testis in which the spermatic vessels need cutting off.