This study highlights the surgical commitment for units caring for patients with spina bifida, the important considerations for the future healthcare services, and the range and severity of urological diseases encountered by these patients.

While a seasonal effect on maternal hCG was demonstrated our data does not suggest this to be the sole cause for cryptorchidism or hypospadias or to account for the observation that both have a seasonal frequency.

plained of groin pain and on examination his right testis Case reports was displaced into the pubic area, with associated haematoma. The testis could not be replaced in the scrotum. Patient 1At operation, a viable testis was found at the superficial inguinal ring. It was easily placed in the scrotum and An 18-year-old motorcyclist was involved in a lowvelocity (#30 mph) head-on collision with an auto-orchidopexy performed. The patient made a good recovery. mobile. On arrival in the emergency department he complained of bilateral groin pain. On examination his scrotum was empty; the right testis was palpable in the Comment distal inguinal canal and the left testis was impalpable. The patient give no history of retractile testes and Fewer than 100 cases of testicular dislocation secondary to trauma have been reported [1,2]; motorcycle accidents reported that before the accident both testes were in the scrotum. At operation the right testis was just distal to were the commonest cause of such injuries and most patients were treated surgically, but successful closed the superficial inguinal ring and the left testis was found at the deep inguinal ring. Both testes were viable but reduction in the emergency department has been described [2]. These cases emphasize the need for vigil-bruised. Bilateral orchidopexy was performed with no diBculty and the patient made an uncomplicated ance in cases of blunt scrotal trauma. In the event of testicular dislocation, closed reduction may be attempted recovery.if the testis is palpable in the upper scrotum, but open retrieval and orchidopexy may be required. It is unlikely Patient 2 that closed reduction would be successful in testicular transeptal dislocation. A 20-year-old man presented complaining of groin pain and absence of his left testis. Before a motorcycle accident one month previously he claimed that both testes were normally positioned in the scrotum. After the accident he presented to another hospital and was found to have References a large scrotal haematoma. He was managed conserva-1 Mikami O, Fujita I, Doi T, Kawamura H, Matsuda T, Komatz Y. Traumatic dislocation of the testis. Acta Urol Jap 1992; tively and the haematoma subsided. On examination, 38: 1075-8 the left side of the scrotum was empty but both testes 2 Madden JF. Closed reduction of a traumatically dislocated were palpable in the right hemiscrotum. The scrotum testicle. Acad Emerg Med 1994; 1: 272-5 was explored and residual haematoma found in relation to a defect in the scrotal septum, through which the intact left testis had been dislocated. This gonad was easily repositioned in the left hemiscrotum and the septal Authors defect repaired. The patient made an excellent recovery C. O'Donnell, MB, Urology SHO. and the groin pain resolved. A 22-year-old man presented after a low-velocity motorcycle accident, having crashed into a wall. He com-768

SUMMARY Cryptorchidism occurs in about 1% of boys, but has a raised incidence in those with deficiencies of androgen function. Greater knowledge of fetal‐maternal endocrinology and related experimental work has provided evidence that fetal testicular endocrine function is vital in descent of the gonad. The therapeutic use of hCG has, however, been disappointing, and its role is confined to helping to distinguish the retractile from the undescended testis. Cryptorchidism is commonly associated with congenital pathological defects such as ductal abnormalities, and others (including interstitial fibrosis and a reduction in germ cells) develop after 1‐2 years, while later these patients are at greater risk of carcinoma in situ and germ cell cancer. The demonstration of the early pathological changes has recently dictated much earlier surgical correction, but long‐term follow‐up is needed to prove clinical benefit from this practice.