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Year 2 - Reproduction, Nephrology and Urology > Cryptorchidism > Flashcards

Cryptorchidism Flashcards

1
Q

List the coverings of the testes from superficial to deep.

A 
Skin
Dartos muscles and fascia 
External spermatic fascia 
Cremaster muscle
Cremasteric fascia 
Internal spermatic fascia
Tunica vaginalis 
- parietal layer
- visceral layer
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2
Q

What is a hydrocele and how is it treated?

A

Accumulation of fluid in the peritoneal cavity within the tunica vaginalis
It is left until all the fluid disperses

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3
Q

Describe the descent of the testes.

A

1) the gubernaculum testes form from the lower gubernaculum around week 7 (after mesonephros degeneration)
2) the gubernaculum shortens and pulls the testes down and through the inguinal canal
3) the deferent ductile is dragged behind, and eventually becomes the vas deferens

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4
Q

Which hormones mediate testicular descent?

A

Insl3 and AMH facilitate gubernaculum enhancement

Testosterone facilitates the shortening of the gubernaculum

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5
Q

Which two muscles make up the upper wall of the inguinal canal?

A

Internal oblique muscle

Transverse abdominus muscle

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6
Q

Which two aponeuroses make up the anterior wall of the inguinal canal?

A

Aponeuroses of internal oblique

Aponeuroses of external oblique

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7
Q

Which two ligaments make up the lower wall of the inguinal canal?

A

Inguinal ligament

Lacunar ligament

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8
Q

Which two Ts make up the posterior wall of the inguinal canal?

A

Transversalis fascia

Conjunct tendon

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9
Q

Briefly describe a clinical examination of the testes.

A

Wash hands, introductions and ask for chaperone
Abdominal exam
Move from standing to lying down and ask about pain
Palpation
Describe the masses
Feel for lymph nodes
Differential diagnosis of lumps in the groin

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10
Q

What congenital conditions does decreased functioning of leydig cells produce?

A

Cryptorchidism
Hypospadias
- due to impaired Insl3 and testosterone production

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11
Q

What congenital conditions does decreased functioning of sertoli cells produce?

A

Infertility
Testicular germ cell cancer
- due to diminished capacity to nurture the germ cells

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12
Q

What are the long term consequences of untreated Cryptorchidism?

A

Problems with spermatogenesis

Risk of testicular cancer

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13
Q

What does prenatal testicular maldevelopment often result in?

A

Smaller testicles

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14
Q

Describe the three positions a testicle can be found in in Cryptorchidism?

A

Abdominal - can’t be felt
Inguinal - can be felt during a very through exam
Prescrotal - can be felt, just not in position

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15
Q

At what age should a baby with undescended testicles be referred for surgery?

A

6 months

- most cases have descended by then

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16
Q

Why are abdominal testicles such a problem?

A

Because if you can’t feel them, you don’t know if the baby actually has them or not.

17
Q

List the risk factors for cryptorchidism.

A

Low birthweight (

18
Q

Name some of the common diseases that can also cause cryptorchidism.

A

Prune belly
Rubinow
Noonan
Fraser syndrome

19
Q

Name some of the more unusual diseases that can cause cryptorchidism.

A

Down’s syndrome
Treacher-Collins
DeLange
Apert

20
Q

Name a situation in which you would not operate on undescended testes?

A

When the cause of the problem is a disease that will also render the patient infertile in adulthood anyway

21
Q

What is the semen quality of adult men with persistent bilateral Cryptorchidism before and after surgery?

A

Azoospermia before

28% with normal sperm count afterwards

22
Q

What is the semen quality of adult men with persistent unilateral cryptorchidism before and after surgery

A

49% have normal sperm concentration before

71% have normal sperm concentration after

23
Q

How many testicular cancers are caused by cryptorchidism?

A

5%

24
Q

Which kind of cryptorchidism poses the greatest risk of testicular cancer?

A

Bilateral

Abdominal

25
Q

List the possible investigations for diagnosing cryptorchidism?

A

Ultrasound
CT/MRI
Laparoscopy
Karyotyping

26
Q

Which two ways can cryptorchidism be treated?

A

Surgically

Hormonally

27
Q

At what age is a orchidoplexy most often performed?

A

6-10 months

28
Q

What follow ups are performed post-op?

A

Clinical examination at 12 months

Follow up at puberty in the bilateral cases

29
Q

What are some of the possible immediate consequences of orchidopexy?

A

Heamatoma
Pain
Infection of the wound

30
Q

What are some of the possible long-term complications of an orchidopexy?

A

Testicular atrophy

Recurrent cryptorchidism

31
Q

What are the two hormonal treatments and what is their function?

A

Human chorionic gonadotropin stimulation test
Luteinising releasing hormone test
These are both supposed to release testosterone

32
Q

How effective is hormonal treatment?

A

Depends on where the testes were initially

- around 25% reascend later on

33
Q

What are the side effects of hormonal treatment?

A 
Pain
Penile growth 
Groin pain
Behavioural problems 
Temporary inflammatory changes in the testes
Reduced testicular volume in adults
34
Q

Describe hypospadias.

A

Ectopically positioned urethral meatus lies proximal to the normal site and on the ventral aspect of the penis

35
Q

What are some of the associated anomalies for hypospadias?

A

Chordee

Hooded foreskin

36
Q

What are the causes of hypospadias?

A 
Not clear
Hormonal fluctuations - testosterone and progesterone 
Advanced maternal age 
IVF baby
Genetic factors 
Reduced sensitivity to androgens
37
Q

What is the treatment for hypospadias?

A

Surgery - foreskin is used to elongate the urethra

- requires multiple processes using mus costal grafting

38
Q

What are some of the side effects of hypospadias surgery?

A

Scarring
Curvature
Strictures
Fistulas

Year 2 - Reproduction, Nephrology and Urology (14 decks)

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