Cryptorchidism Flashcards
What is cryptorchidism?
- = Undescended testis (es)
Differentiate congenital vs acquired cryptorchidism.
- Congenital: usually can’t find cause
○ Ectopic testis
○ Agenesis
○ Disorder of sexual differentiation - Acquired
- Between 1-10yo
- Common: spermatic cord fails to grow at same rate - pulls testes back up
- Trauma (e.g. dislocation, rupture)
- Previous disease (e.g. tumour, torsion and subsequent infarction)
Differentiate undescended and ectopic cryptorchidism.
- Undescended = in line of normal descent
2. Ectopic = outside line of normal descent
When does testes descent occur in utero?
8mo gestation
What is the most common reason of failure of the spermatic cord to grow?
Failure of complete obliteration and resorption of processus vaginalis, which leave a fibrous remnant which prevents elongation of vas and vessels with growth. In boys with cerebral palsy, cause may be abnormal tone in cremaster muscle.
Differentiate retractile and ascending cryptorchidism.
- Retractile = normally descended testis that may be brought to base of scrotum, and remains there temporarily after manipulation
- Ascending = previous descended testis but no longer resides in the lower scrotum because of spermatic cord tension or tethering
Complications of cryptorchism
- Trauma such as twisting (torsion).
- Hernia - loops of bowel coming through the same hole as the testis.
- Lower fertility - the body temperature in the abdomen is higher than in the scrotum.This can affect sperm production in the testes.
- Risk of testicular cancer - happens in a relatively low number of boys.The risk is usually less than 1 in 100.
- Poor self esteem
What is the Ix of choice for an impalpable testis?
Laparoscopy
What surgery can be done to fix undescended testis? When should it be done?
Orchidopexy:
- 6-12mo for congenital
- for acquired that is non-retractile
