undescended testis

undescended testis

1. UNDESCENDED
TESTIS

2. Cryptorchidism
•Cryptos = hidden
•Orchis = testis
UDT
retractile ectopic

3. Undescended Testis
•Testis located anywhere along
the normal path of descent , but
not reached the scrotum

4. •Ectopic Testis :
•Deviation from the normal path of
descent
• Retractile Testis:
• Due to a hyperreflexic
cremaster
muscle

5. Embryology
•Development – from genital fold
•Descent – 3 phases
Intra abdominal (1-7 months)
Canalicular (7-8 months)
Scrotal (8-9 months)

6. Factors affecting descent
•Mechanical
• Hormonal
• Growth
factors

7. Mechanical factors
•Intra abdominal pressure
•Processus vaginalis
•Gubernaculum

8. •Gubernaculum – fibromucinous band
connecting proximal tip of vas deferens
to the root of scrotum
Fascia lata in femoral triangle
Pubic tubercle
perineum
scrotum

9. •Hormonal factors :
Testosterone – produced by leydig
cells
• Growth factors :
Epidermal growth factor
Calcitonin gene related peptide

10. History
•Empty scrotum since birth
•May have a swelling in the groin
which is reducible
•May present to the doc with
complications

11. Clinical features
•Empty scrotum
•Underdeveloped
scrotum
•Testis may or may
not be palpable
along the path of
descent

12. Why to treat?-complications
Infertility
Trauma
Torsion
Malignant Change
Psychological

14. unilateral bilateral
palpable
impalpable
palpableimpalpable
UDT

15. 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

17. Surgery- unilateral
Palpabl
e
Impalpable
orchiopexy
laparoscopy
orchiopexy
Blind ending vessels
(monorchia)
Terminate
procedure
Vessels exiting
internal ring
Inguinal exploration
orchiectomy
Intra abd testis
Fowler
Stephens
orchiopexy

18. Surgery - bilateral
palpable
orchiopexy
impalpable
HCG
No response
anorchia
Increased testosterone
Laparoscopy &
proceed

19. When to operate?
•One year of age

20. Orchiopexy
•Groin incision
•Divide
gubernaculum
•Herniotomy
•Divide bands holding
the vessels to lateral
abd wall

21. •Medialize the vas &
vessels
•Fix the mobilized
testis in scrotal
pouch (extra dartos
or sub dartos)

22. Hypospadias

23. Abnormal location of the meatus
on the undersurface of the penis
Types :
glanular
penile
penoscrotal
perineal
coronal

24. Characteristic features
•Hooded prepuce
•Meatus located on ventral
aspect
•Glans flat & not conical
•Ventral curvature of shaft
( CHORDEE)

26. 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

27. Urethroplasty