Cryptorchidism Flashcards
List the coverings of the testes from superficial to deep.
Skin Dartos muscles and fascia External spermatic fascia Cremaster muscle Cremasteric fascia Internal spermatic fascia Tunica vaginalis - parietal layer - visceral layer
What is a hydrocele and how is it treated?
Accumulation of fluid in the peritoneal cavity within the tunica vaginalis
It is left until all the fluid disperses
Describe the descent of the testes.
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
Which hormones mediate testicular descent?
Insl3 and AMH facilitate gubernaculum enhancement
Testosterone facilitates the shortening of the gubernaculum
Which two muscles make up the upper wall of the inguinal canal?
Internal oblique muscle
Transverse abdominus muscle
Which two aponeuroses make up the anterior wall of the inguinal canal?
Aponeuroses of internal oblique
Aponeuroses of external oblique
Which two ligaments make up the lower wall of the inguinal canal?
Inguinal ligament
Lacunar ligament
Which two Ts make up the posterior wall of the inguinal canal?
Transversalis fascia
Conjunct tendon
Briefly describe a clinical examination of the testes.
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
What congenital conditions does decreased functioning of leydig cells produce?
Cryptorchidism
Hypospadias
- due to impaired Insl3 and testosterone production
What congenital conditions does decreased functioning of sertoli cells produce?
Infertility
Testicular germ cell cancer
- due to diminished capacity to nurture the germ cells
What are the long term consequences of untreated Cryptorchidism?
Problems with spermatogenesis
Risk of testicular cancer
What does prenatal testicular maldevelopment often result in?
Smaller testicles
Describe the three positions a testicle can be found in in Cryptorchidism?
Abdominal - can’t be felt
Inguinal - can be felt during a very through exam
Prescrotal - can be felt, just not in position
At what age should a baby with undescended testicles be referred for surgery?
6 months
- most cases have descended by then
Why are abdominal testicles such a problem?
Because if you can’t feel them, you don’t know if the baby actually has them or not.
List the risk factors for cryptorchidism.
Low birthweight (
Name some of the common diseases that can also cause cryptorchidism.
Prune belly
Rubinow
Noonan
Fraser syndrome
Name some of the more unusual diseases that can cause cryptorchidism.
Down’s syndrome
Treacher-Collins
DeLange
Apert
Name a situation in which you would not operate on undescended testes?
When the cause of the problem is a disease that will also render the patient infertile in adulthood anyway
What is the semen quality of adult men with persistent bilateral Cryptorchidism before and after surgery?
Azoospermia before
28% with normal sperm count afterwards
What is the semen quality of adult men with persistent unilateral cryptorchidism before and after surgery
49% have normal sperm concentration before
71% have normal sperm concentration after
How many testicular cancers are caused by cryptorchidism?
5%
Which kind of cryptorchidism poses the greatest risk of testicular cancer?
Bilateral
Abdominal
List the possible investigations for diagnosing cryptorchidism?
Ultrasound
CT/MRI
Laparoscopy
Karyotyping
Which two ways can cryptorchidism be treated?
Surgically
Hormonally
At what age is a orchidoplexy most often performed?
6-10 months
What follow ups are performed post-op?
Clinical examination at 12 months
Follow up at puberty in the bilateral cases
What are some of the possible immediate consequences of orchidopexy?
Heamatoma
Pain
Infection of the wound
What are some of the possible long-term complications of an orchidopexy?
Testicular atrophy
Recurrent cryptorchidism
What are the two hormonal treatments and what is their function?
Human chorionic gonadotropin stimulation test
Luteinising releasing hormone test
These are both supposed to release testosterone
How effective is hormonal treatment?
Depends on where the testes were initially
- around 25% reascend later on
What are the side effects of hormonal treatment?
Pain Penile growth Groin pain Behavioural problems Temporary inflammatory changes in the testes Reduced testicular volume in adults
Describe hypospadias.
Ectopically positioned urethral meatus lies proximal to the normal site and on the ventral aspect of the penis
What are some of the associated anomalies for hypospadias?
Chordee
Hooded foreskin
What are the causes of hypospadias?
Not clear Hormonal fluctuations - testosterone and progesterone Advanced maternal age IVF baby Genetic factors Reduced sensitivity to androgens
What is the treatment for hypospadias?
Surgery - foreskin is used to elongate the urethra
- requires multiple processes using mus costal grafting
What are some of the side effects of hypospadias surgery?
Scarring
Curvature
Strictures
Fistulas
