Absent testis: does it exist in 46,XY males?

Abstract

Aim To challenge the concept of genetically absent testis in normal 46,XY males.
Background The term absent testes has been used in the literature to denote vanishing testis, atrophied testis, nubbin of testicular tissue, or genetically absent testes. When no testicular tissues are found during diagnostic laparoscopy, the vas and testicular vessels are traced as leading pointsfor testicular localization, and if both end
blindly at a closed ring, vanishing testis is diagnosed. When the vas and vessels are seen entering the canal, a testicular nubbin may be present at the end of the epididymis.
Methods Both Mullerian inhibitory factor and testosterone act locally as paracrine hormones. Unilateral absent testis should be associated with an ipsilateral persistent of Mullerian tissues. Individuals with bilateral testicular agenesis will develop into a phenotypic female with persistent Mullerian structures.
Results The absence of Mullerian structures in patients with impalpable testis means that there has been a functional testis that survived well beyond the ninth week of gestation. We have encountered testicles at the subrenal position after an initial laparoscopic finding of an absent.
Conclusion Based on embryological process of testicular development and testicular descent, agentic absent testis cannot exist. Therefore we strongly recommend to re-scope all patients who were initially diagnosed as absent testis to look for a hidden testis at the initial site of development and along the line of descent. 

Keywords: absent testis, undescended testis, vanishing testis