W4L7 Cryptorchidism

Question 1

Def?

Answer 1

Absence one/both testes from scrotum

Question 2

Incidence?

Answer 2

–In full term infants(3%)

–In preterm infants(30%)

Question 3

Factors help descent of testis?

Answer 3

1. Presence of gubernaculum.
2. Increase intra-abdominal pressure
3. Role some hormones(androgens & HCG)
   - Completion of descent testis occur by the 35th week of gestation

Question 4

Classification

Answer 4

1. Undescended testis
   - abd. -inguinal canal -upper scrotum
2. Ectopic testis.
   - penis(root) -femoral canal -perineum
3. Retractile testis.
4. Ascending testis

Question 5

Presentation?

Answer 5

1. Neonate
   - testicular exam(mandatory)
   - diagnosed after birth
   - Spontaneous descent(75%)
2. Older child
   - acci discover
   - dif retractile & UDT

Question 6

Examination

Answer 6

Clinical exam(gold standard) diagnose UDT & dif form retractile testis

• General:
–Asso anomalies cases syn(Prune belly syn)
• Abdominal:
–Abd mass asso w Wilm’s tumor
• Local:
– Testicular exam
– Contralateral testis
– Asso hypospadias, hernia, ambiguous genitalia

Question 7

Technique of examination

Answer 7

1) Pt supine in frog leg position w
both legs free
2) W warm hand, check size, location & texture contralateral descended testis (CDT)
3) Begin exam UDT at anterior superior iliac spine & sweep groin from lateral to medial w nondominant hand.
4) Once testis palpated, grasp w dominant hand & continue sweep testis toward scrotum w other hand
5) W combination sweeping & pulling, sometimes bring testis to scrotum.
6) Maintain position testis in scrotum for minute, so cremaster muscle fatigued.
7) Release testis & if remains in place, it retractile testis. If immediately pops back to prescrotal position, it UDT

Question 8

Complications

Answer 8

• Infertility
• Testicular atrophy.
• Tumor development.
• Epididymo-orchitis of UDT can mimic appendicitis.
• Psychological effects of UDT.
• Hernia
• Tortion
• Trauma
• Hypogondism

Question 9

Inv

Answer 9

1. Radiology
   - abd us &MRI
2. Laboratory
   - in bilateral non palpable UDT
   • Karyotyping.
   • FSH, androgens, HCG & estrogen

Question 10

Management

Answer 10

1. Goal ttt
   - Testicular fx preservation.
   - Reduce risk & facilitate diagnosis testicular tumor
   - Provide cosmetic benefit
2. Expectant management
   - Diagnosed at birth
   - Exam every 3 months
   - Spontaneous descent testis can occur till age 6 month
3. Hormonal treatment
   - HCG & LHRH
   - Descent(20%) by effect on gubernaculum
4. Surgical
5. Bl supply testis
   - Testicular artert
   - Artery of Vas
   - Cremasteric artery
6. Steven-Fowler’s orchioexy