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