UNDESCENDED
TESTIS
Cryptorchidism
• Cryptos = hidden• Orchis = testis
UDT
retractile ectopic
Undescended Testis
• Testis located anywhere along the normal path of descent , but not reached the scrotum
•Ectopic Testis :• Deviation from the normal path
of descent
• Retractile Testis:• Due to a hyperreflexic cremaster muscle
Embryology
• Development – from genital fold
• Descent – 3 phases Intra abdominal (1-7 months)Canalicular (7-8 months)Scrotal (8-9 months)
Factors affecting descent
• Mechanical
• Hormonal
• Growth factors
Mechanical factors
• Intra abdominal pressure
• Processus vaginalis
• Gubernaculum
• Gubernaculum – fibromucinous band connecting proximal tip of vas deferens to the root of scrotum
Fascia lata in femoral triangle
Pubic tubercle
perineumscrotum
•Hormonal factors :Testosterone – produced by
leydig cells
• Growth factors :Epidermal growth factorCalcitonin gene related peptide
History
• Empty scrotum since birth
•May have a swelling in the groin which is reducible•May present to the doc with complications
Clinical features
• Empty scrotum
• Underdeveloped scrotum
• Testis may or may not be palpable along the path of descent
Why to treat?-complications
Infertility
Trauma
Torsion
Malignant Change
Psychological
unilateral bilateral
palpableimpalpable
palpable impalpable
UDT
When do we investigate?
• If palpable- no inv needed
• Unilateral impalpable- no inv needed, but USG is done by many
• Bilateral impalpable- rule out INTERSEX
Surgery- unilateral Palpable Impalpable
orchiopexy laparoscopy
orchiopexy
Blind ending vessels(monorchia)
Terminate procedure
Vessels exiting internal ring
Inguinal exploration
orchiectomy
Intra abd testis
Fowler Stephens orchiopexy
Surgery - bilateral
palpable
orchiopexy
impalpable
HCG
No response
anorchia
Increased testosterone
Laparoscopy & proceed
When to operate?
•One year of age
Orchiopexy • Groin incision
• Divide gubernaculum
• Herniotomy
• Divide bands holding the vessels to lateral abd wall
• Medialize the vas & vessels
• Fix the mobilized testis in scrotal pouch (extra dartos or sub dartos)
Hypospadias
Abnormal location of the meatus on the undersurface of the penis
Types :glanular
penile
penoscrotal
perineal
coronal
Characteristic features
• Hooded prepuce
• Meatus located on ventral aspect
• Glans flat & not conical
• Ventral curvature of shaft ( CHORDEE)
Treatment
• DO NOT CIRCUMCISE- prepuce can be used to construct a neo urethra
• USG abd to rule out internal urinary tract pathology
• Ideal age: >6 months- 2yrs• Surgery : urethroplasty
Urethroplasty