Tag: Undescended Testes

Undescended Testes

Undescended Testes


UNDESCENDED TESTES

  • Incidence: In premature infants: 30%; In full term infants: 4%; At 3 months- 2%
  • Testis absent from scrotum after 3 months of age are unlikely to descent fully
  • Incompletely descended testis tends to atrophy as puberty approaches
  • More common on the right side(50%) and 20% cases are bilateral (cryptorchidism)
  • Secondary sexual characters are normal 

Etiology

  • Gubernacular dysfunction
  • Lack of gonadotropins [HCG]
  • Lack of CGRP –calcitonin gene related peptide
  • Prune Belly syndrome
  • Familial 

Complications

  • Torsion
  • Epididymo-orchitis(may mimic appendicitis)
  • Sterility (in bilateral cases, especially- intraabdominal testis)
  • Indirect Inguinal hernia
  • Increased liability to malignant disease
  • Atrophy 

Treatment

  • Orchidopexy is usually done before 6 months of age
  • Orchidectomy: if the incompletely descended testis is atrophic, if patient is past puberty & other testis is normal
  • In bilateral cases, testis is passed into the opposite scrotum through an opening in the scrotal septum – Ombredanne’s operation
  • HCG or GnRH can be given when cryptorchidism is associated with hypogenitalism and obesity
Exam Question
 
  • Orchidopexy is usually done before 6 months of age
  • Orchidectomy: if the incompletely descended testis is atrophic, if patient is past puberty & other testis is normal
  • In bilateral cases, testis is passed into the opposite scrotum through an opening in the scrotal septum – Ombredanne’s operation
  • HCG or GnRH can be given when cryptorchidism is associated with hypogenitalism and obesity
Don’t Forget to Solve all the previous Year Question asked on Undescended Testes

Undescended Testes

UNDESCENDED TESTES

Q. 1

Surgery for undescended testes is ideally performed before what age?

 A

6 months

 B

12 months

 C

24 months

 D

36 months

Q. 1

Surgery for undescended testes is ideally performed before what age?

 A

6 months

 B

12 months

 C

24 months

 D

36 months

Ans. B

Explanation:

Surgical correction of undescended testis should be done at 6 months and maximum by 1 year.
 
Ref: Nursing care of the pediatric surgical patient By Nancy Tkacz Browne, Page 147-8; CPDT 20th Edition, Page 974.

Q. 2

Orchidopexy is done in cases of undescended testes at the age of:

 A

Infancy

 B

1-2 yrs

 C

5 yrs

 D

Puberty

Q. 2

Orchidopexy is done in cases of undescended testes at the age of:

 A

Infancy

 B

1-2 yrs

 C

5 yrs

 D

Puberty

Ans. A

Explanation:

Spontaneous descent of testes rarely occur after 6 months of age and histologic changes related to infertility occur in the undescended testicle as young as 1 year of age, so surgical repair should ideally be done between 6 months and 1 year.

 
In cryptorchidism the undescended testes may remain in the abdominal cavity, inguinal canal or just outside the external ring.

The left testicle is affected more often. 
 
In children with bilateral nonpalpable testes hormonal evaluation should be done.

If the levels of LH and FSH are elevated and mullerian inhibitory substance is absent the diagnosis of testicular absence can be made
.
Testicular absence can be confirmed by a negative human chorionic gonadotropin stimulation test.
 
Ref: CURRENT Diagnosis & Treatment: Surgery, 13e chapter 38.

Q. 3

Orchidopex is done in cases of undescended testes at the age of –

 A

Neonate

 B

1-2 yrs

 C

5 yrs

 D

Puberty

Q. 3

Orchidopex is done in cases of undescended testes at the age of –

 A

Neonate

 B

1-2 yrs

 C

5 yrs

 D

Puberty

Ans. B

Explanation:

Ans. is ‘b’ i.e., 1-2 years

“Congental undescended testis should be treated surgically no later than 9-15 months. Surgical correction at 6 months is appropriate”.  – Nelson

Crvptorchidism

o An undescended testis (cryptorchid) is the most common disorder of sexual differentiation in boys.

o At birth approximately 4-5% of boys have an undescended testis.

  • The majority of undescended testes descend spontaneously during the first 3 months of lift, and by 6 month the incidence decreases to 0.8%.

o If the testis has not descended at 4 months, it will remain undescended.

o Cryptorchidism is bilateral in 20% of cases.

Consequences of cryptorchidism

o Infertility                                                                                        

o Torsion

o Testicular maligancy —-> Most common seminoma              

o Associated hernia

o Psychological effects of empty scrotum.


Q. 4

Unilateral undescended testes is ideally operated around-

 A

2 months of age

 B

6 months of age

 C

12 months of age

 D

24 months of age

Q. 4

Unilateral undescended testes is ideally operated around-

 A

2 months of age

 B

6 months of age

 C

12 months of age

 D

24 months of age

Ans. B

Explanation:

Ans. is ‘b’ i.e., 6 months of age


Q. 5

Orchidopexy is done in cases of undescended testes at the age of

 A

Infancy

 B

1-2 yrs

 C

5 yrs

 D

Puberty

Q. 5

Orchidopexy is done in cases of undescended testes at the age of

 A

Infancy

 B

1-2 yrs

 C

5 yrs

 D

Puberty

Ans. A

Explanation:

Ans. is ‘a’ i.e. Infancy 

  • Campbell’s Urology writes –

“Definitive treatment of an undescended testis should take place between 6 and 12 months of age. Because spontaneous descent occurs in most boys by 3 months of age and uncommonly thereafter, earlier interventions should be considered in order to theoretically prevent the complication of cryptorchidism that may be manifested before 1 yr of age”.


Q. 6

Orchidopexy in an undescended testes decreases all except –

 A

Tumour incidence

 B

Epididymoorchitis

 C

Torsion

 D

Avoid sexual ambiguity

Q. 6

Orchidopexy in an undescended testes decreases all except –

 A

Tumour incidence

 B

Epididymoorchitis

 C

Torsion

 D

Avoid sexual ambiguity

Ans. A

Explanation:

Ans. is ‘a’ i.e., Tumour incidence 



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