L3: Undesecended Testes Flashcards
Def of Cryptochidism / Undescended Testis
Cryptorchid testes are testes not located normally in the scrotum.
Epidemeology of Cryptochidism / Undescended Testis
Etiology of Cryptochidism / Undescended Testis
- Undescended testis is caused by any anomaly of hormonal control or anatomical processes required for normal testicular aescent.
Classification of Cryptochidism / Undescended Testis
Classification of Cryptochidism / Undescended Testis
- Arrest in normal descent
Classification of Cryptochidism / Undescended Testis
- arrest outside the normal line of descent
Def of Retractile Testis
- Retractile testes are testes which retract out of scrotum on stimulation of sensory branch of genitofemoral nerve (stimulation of cremastric reflex)
- but then return to scrotum within 10-20 seconds.
TTT of Retractile Testis
Diagnosis of Retractile Testis → No surgical treatment is required.
Def of Ascending Testis
- Ascending testis is a testis that was in scrotum at birth/ 3 months of age but then reascends with progressive increase in size of boy.
Causes of Ascending Testis
- It is caused by a persistence of an obliterated fibrous remnant of processus vaginalis) that hinders the normal process of growth & elongation of the spermatic cord with age.
- Testicular ascent may also be acquired by fibrosis resulting from previous groin operation (e.g: Inguinal hernia repair).
Complications of Cryptochidism
Complications of Cryptochidism
- Infertility
- Unilateral UDT → Fertility is eauivalent to that of the normal population (~90%).
- Bilateral UDT → paternity rates of 50-65% even if corrected early
Complications of Cryptochidism
- Malignancy
- Risk in abdominal testes > Inguinal testes
Complications of Cryptochidism
- Inguinal Hernia
(patent processus vaginalis)
Complications of Cryptochidism
- testicular Torsion
- As the testis is not fixed to the scrotum and more mobile (especially when at superficial inguinal pouch)
Complications of Cryptochidism
- Trauma
The testis is more liable to trauma at inguinal or abdominal position.
Complications of Cryptochidism
- Psychological Effect
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Dx of Cryptochidism
Dx of Cryptochidism
- Clinical Dx
Dx of Cryptochidism
- INVx
Dx of Cryptochidism
- Labs
Dx of Cryptochidism
- Rad
Dx of Cryptochidism
- Laparoscopy
current gold standard
Management of Cryptochidism
- Hormonal TTT
- Surgical TTT
Management of Cryptochidism
- Hormonal TTT
Management of Cryptochidism
- SE of Hormonal TTT
Management of Cryptochidism
- Is Hormonal TTT First Line?
Many surgeons do not consider the success rates high enough to be worth the trouble since surgery itself is usually simple and uncomplicated.
Management of Cryptochidism
- Surgical
Surgical TTT of Cryptochidism
Surgical TTT of Cryptochidism
- Timing
Surgical TTT of Cryptochidism
- Benifits
Surgical TTT of Cryptochidism
- Principles
Surgical TTT of Cryptochidism
- Approaches
