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On a sunny day, a 2-year-old boy came to the paediatric department with skin abnormalities. These had started as redness and blisters and later also included hyperpigmentation. He had played near a phototoxic plant known as 'common rue' (Ruta graveolens). Our diagnosis was phytophotodermatitis caused by the common rue.

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PURPOSE: The purpose of the study is to study the natural course of undescended testes after inguinoscrotal surgery. METHODS: From 2003-2010, 24 boys were observed with 26 undescended testes after inguinoscrotal surgery; 12 had previously undergone inguinal hernia repair and 12 orchidopexy. Spontaneous descent was awaited and (re-)orchidopexy would only be performed in case of non-descent at puberty. The boys were assessed annually for testis position and for testis volume as measured by ultrasound. RESULTS: At the end of the study period, 19 testes had reached scrotal position; of these, 13 (68%) had descended spontaneously and 6 (32%) had been (re-)orchidopexied. No difference was found in the rate of spontaneous descent after previous orchidopexy or inguinal hernia repair (P=0.419). CONCLUSION: Spontaneous descent of undescended testes after inguinoscrotal surgery occurs regularly. In this study, it was observed in two out of every three cases.

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OBJECTIVE: To assess prospectively the natural history and long-term testicular growth of acquired undescended testis (UDT) after spontaneous descent or pubertal orchidopexy in case of nondescent. PATIENTS AND METHODS: From 1996 until 2008, 391 boys with 464 acquired UDT were included in the study. In accordance with Dutch consensus on non-scrotal testes, spontaneous descent at puberty was awaited; if this did not take place, orchidopexy was performed at puberty. Acquired UDT was defined as a testis previously residing in the scrotum that can no longer be manipulated into a stable scrotal (high scrotal) or nonscrotal (inguinal, impalpable) position. After referral, testis position, testis volume and puberty stage were monitored annually until adolescence. Testis volume was assessed using an orchidometer and compared with the Dutch standard. All investigations were carried out by the same physician (W.H.). Of these boys, 84 (mean age 12.9 years, range 6.4-21.3) were also clinically assessed by a second physician (J.G.), unaware of the results of the first examination. In addition, these boys were assessed with testicular ultrasonography, carried out by both physicians. RESULTS: Currently the mean (range) follow-up is 4.7 (0.1-12.0) years, and 253 acquired UDT have reached the scrotum. In 196 of these 253 cases (77.5%), there was spontaneous descent at puberty (mean age at descent 12.9 years, range 9.8-16.9); in the other 57 cases (22.5%), pubertal orchidopexy was required due to nondescent; five cases required orchidectomy. Of the 494 testis volume measurements after spontaneous descent, 458 (92.7%) were at ≥10th centile for age, of which 311 (63.0%) were ≥50th centile, and 107 (21.7%) ≥90th centile. After pubertal orchidopexy for nondescent, of the 85 measurements, 79 (92.9%) were at ≥10th centile, 53 (62.4%) ≥50th centile and 12 (14.1%) ≥90th centile. In unilateral cases, after spontaneous descent 174 of the 294 (59.2%) retained testes were found to be smaller than their counterpart and 90 of 294 (30.6%) were equal in size. After pubertal orchidopexy in unilateral cases, 40 of the 51 (78.4%) testes were smaller, and nine (17.6%) were equal in size. There was a strong correlation between both investigators for the measurement of testicular volume by orchidometer, and for the main investigator (W.H.) between his measurements by ultrasonography and the Prader orchidometer. CONCLUSION: Acquired UDT has a 77.5% tendency of spontaneous descent at puberty. In nearly all cases, after spontaneous descent as well as after pubertal orchidopexy, long-term testicular growth is within the normal range.

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PURPOSE: We assessed the prevalence of testicular microlithiasis by ultrasound in boys and young men with congenital or acquired undescended (ascending) testis. MATERIALS AND METHODS: During followup for testicular growth patients with congenital or acquired undescended (ascending) testis were also screened by ultrasound for testicular microlithiasis, which was defined as echogenic foci without shadowing within the testis parenchyma. Classic microlithiasis was defined as 5 or more echogenic foci in either or both testes and limited microlithiasis as fewer than 5 foci. RESULTS: We performed 181 ultrasounds in 181 patients (199 congenital undescended testes) with a mean age of 12.6 years (range 2.6 to 28.6) and 636 ultrasounds in 320 patients (350 acquired undescended/ascending testes) with a mean age of 12.4 years (4.1 to 24.1). Age in both patient groups was equivalent. Median followup was 1.34 years (range 0 to 3.2). Testicular microlithiasis was found in 14 patients (2.8%), of whom 11 (2.2%) displayed classic testicular microlithiasis and 3 (0.6%) exhibited limited testicular microlithiasis. Among these 14 patients 5 had congenital undescended testes, which demonstrated classic microlithiasis. Of these 5 patients 4 had chromosomal deformities. The remaining 9 patients had acquired undescended (ascending) testis, which exhibited classic microlithiasis in 6 instances and limited microlithiasis in 3. CONCLUSIONS: The prevalence of testicular microlithiasis in patients with undescended testis is 2.8%. There is no difference in the prevalence of testicular microlithiasis between congenital and acquired undescended (ascending) testes.

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BACKGROUND: At present, the high scrotal testis is considered a distinct and separate entity of undescended testis. OBJECTIVES: The aim of this study was to assess whether high scrotal testis is actually either a congenital- or acquired-undescended testis. DISCUSSION: In 527 consecutive boys (aged 0.4 to 16.5 years, mean 7.5) referred for non-scrotal testis, the number of high scrotal testis was prospectively determined. According to previous testis position, the high scrotal testis was classified into congenital- and acquired-high scrotal testis. In congenital-high scrotal testis orchidopexy was performed whereas spontaneous descent at puberty was awaited in acquired-high scrotal testis. In 210 testes, the gonad was diagnosed as high scrotal. In six testes the condition was congenital and 204 testes were diagnosed as acquired. All cases of congenital-high scrotal testis were treated surgically. In 100 acquired-high scrotal testis follow-up was performed. Of these, 75 testes descended spontaneously at puberty. CONCLUSION: We propose that the high scrotal testis should be regarded, not as a distinct and separate entity, but as a part of the spectrum of either congenital-undescended testis or acquired-undescended testis. Since spontaneous descent can occur at puberty in acquired-high scrotal testis, therapy may be different between both forms.

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