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
palpable impalpable
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