Peds Cryptorchidism

Question 1

H&P for cryptorchidism

Answer 1

-Gestational history
-Check for hypo
-Palpate testes at each well child visit
-Refer at 6 months if not descended
-Refer immediately for bilateral UDT or UDT+hypo for DSD workup
-If ascended, check annually

Question 2

Testing for cryptorchidism

Answer 2

Do not get US routinely
Check AMH if bilateral nonpalpable

Question 3

Treatment for cryptorchidism

Answer 3

-Do not use hormone therapy
-If no descend by 6 months, bring down within a year (inguinal or scrotal)
-EUA first if nonpalp
-Explore if nonpalp - rely on vessel status
-Orch if normal contralateral testis and short vessels or small testicle or postpubertal
-Counsel on risks

Question 4

Locations where UDT can reside

Answer 4

Abdominal
Superficial inguinal pouch
At external ring
Canalicular (within canal)
Prescrotal

Question 5

Incidence of cryptorchidism

Answer 5

100% in <900g babies
1-3% in normal term birthweight babies
15-30% in premature babies
1% will require surgery

Question 6

How many UDT spontaneously drop?

Answer 6

35%

Question 7

Risk factors for UDT

Answer 7

Prematurity
Low birth weight
Genetics (INSL3)

Question 8

Surgical technique for inguinal orchidopexy

Answer 8

Exam under anesthesia
If palpable, inguinal orchidopexy
-Incision along langer’s lines
-Identify testicle
-Assess anatomy
-Identify and separate the hernia sac from the vessels
-(assess for contralateral hernia)
-Twist and ligate
-Scrotal incision
-Subdartos pouch
-Three point fixation
-Ensure down

Question 9

Surgical technique for non-palpable testes

Answer 9

Diagnostic laparoscopy
-Access through umbilicus
-Assess for intraabdominal testes
-Assess vessels - if vessels atretic into closed ring, then done
-If normal testicle in abdomen - check to see if testicle will reach contralateral ring - if not, Fowler’Stephens (divide vessels) and stage
-Orch