Cryptorchidism and Hypospadias Flashcards
List the layers of the testis.
Skin and dartos muscle. External spermatic fascia. Cremaster muscle. Internal spermatic fascia. Tunica vaginalis (parietal). Tunica vaginalis (visceral).
What could cause swollen testis?
A hydrocoele (fluid) or a hernia (bowel). Determine which using a light as fluid transilluminates.
When do testicles descend? What growth factors are involved?
Happens in week 28-35.
INSL-3, AMH and testosterone are involved.
Describe the boundaries of the inguinal canal?
MALT
Upper: Internal oblique and transversus abdominis (Muscle).
Anterior: External and interal oblique Aponeurosis
Lower: Inguinal and lacunar Ligament.
Posterior: Transversalis fascia and conjoint Tendon.
Has an internal and external ring.
Describe how cryptorchidism arises?
Impaired fetal testes development leads to decreased functioning of leydig cells.
This causes impaired testosterone and INSL-3 secretion.
This leads to hypospadias/cryptorchidism.
What could occur is impaired fetal development leads to decreased function of sertoli cells?
Unable to nurture germ cells so get reduced fertility.
Could lead to testicular cancer.
What is cryptorchidism?
Impalpable or undescended (palpable) testes.
Can be bilateral or unilateral.
A testicular dysgenesis syndrome.
List the classifications of cryptorchdism?
Abdominal
Inguinal (in inguinal canal)
Prescrotal
Retractile - can change position, can pull down but move up.
What happens if the testicles dont descend after 6 months?
Child is reffered for orchidopexy.
What are the risk factors for cryptorchidism?
Low birth weight (<2.5kg) Small for gestational age Prematurity Maternal diabetes Environmental factors? Smoking, phthalates.
Describe semen quality in men with cryptorchidism?
Bilateral: Have azoospermia (none). After operation 28% have a normal sperm count.
Unilateral: 50% have a normal sperm count. 70% have normal after operation.
Describe cryptorchidism and cancer risk?
Increases risk of testicular cancer.
Around 5% of cases.
Bilateral and/or intra-abdominal carries greatest risk.
Early orchidopexy eliminates risk!
What investigations are performed for cryptorchidism?
US, CT, MRI.
Consider Karyotype - to ensure no abnormal chromosome arrangements.
Biochemical tests to ensure they will function as normal e.g. testosterone.
What treatment can be given for crytorchidism?
Orchidopexy from 6-18 months ideals.
12 months follow up until puberty.
If an op isnt suitable, can get hormone treatment;
- HCG stimulation (mimics LH which can cause a surge in testosterone to help testes descend).
What is a hypospadia? How common is it?
Ectopically positioned external urethral meatus.
1 in 300 births.
