Undescended Undescended Testis Testis

By-By-Gaurav Jadhav. Gaurav Jadhav. Vaibhav Devkar. Vaibhav Devkar.

Undescended testicles.Undescended testicles. An Undescended Testis is one which

has failed to descend to the scrotum and is retained at any point along the “normal path” of its descent.

Undescended Undescended testiclestesticles

RIGHT SIDED50%

LEFT SIDED30%

BILATERAL20%

Descent of the testis.Descent of the testis.At first testis lies on the dorsum of abdominal wallTime-table & its pathway• Lumbar region-2nd month of foetal life• Iliac fossa-3rd month of foetal life• At deep inguinal ring-till 7th month• Travels inguinal canal-in the 7th month• At superficial inguinal ring-at later part

of 7th month or 8th month• Scrotum-in the 9th month.

Factors which cause Factors which cause Descent of the testisDescent of the testis

• Shortening and active contraction of the gubernaculum.

• Increased abdominal pressure• Active muscular (internal oblique)

contractions• Higher temp. of abdominal cavity• Hormone –Chorionic gonadotropin

from maternal circulation

Causes of Undescended Causes of Undescended Testis Testis

• Abnormality of gubernaculum testis• Intrinsic testicular defect• Deficient gonadotrophic hormonal

stimulation• Obstruction due to its adhesions• Short vas deferens & testicular

vessels• Imperfectly developed testis.

Pathology of Undescended Pathology of Undescended testiclestesticles

Growth of the testis : Improper development of spermatogenic

tubules & fewer spermatogonia. Undescended testicles is much smaller (nearly half) and flabby than the normal intrascrotal testis.

Internal secretory function :Leydig cells are not affected by body temperature & so secondary sexual characters appear. However in cryptorchidism, androgen level is diminished.

Pathology of Undescended Pathology of Undescended testiclestesticles

Epididymis remains separated from the testis by a long mesorchium, so torsion of testis is more common.

Undescended testicles may be associated with hernial sac, urinary tract abnormalities.

Chances of malignancy is more in Undescended testicles.

Types of Undescended Types of Undescended testiclestesticles

• Lumbar testis• Iliac testis• Inguinal testis • At superficial inguinal ring• Scrotal testis

Clinical FeaturesClinical FeaturesHISTORY-Age-its usually noticed in children,

but are occasionally not noticed untill adolescents or even adult life.

SYMPTOMSAbsence of one or both testes from scrotum

is commonest presenting symptom.Occasionally patients present in adult life

with infertility though secondary sexual characters are normal.

Rarely patients present with indirect hernia with Undescended testicles

Physical examinationPhysical examinationThe first thing that attracts clinician’s eye is

absence of one or both testis from scrotum.

Testis is only palpable when it is at or outside superficial inguinal ring.

If its not palpable, one can press firmly along the line of inguinal canal to see if there is a tender area or a point where testicular sensation is evoked.

Also rule out indirect inguinal hernia and malignancy.

• Examination of the groin for an Undescended testicle is often enhanced with the use of lubrication. (A) The examining hand is swept along the inguinal canal, starting at the superiolateral extent of the inguinal canal. If the testicle is present, it will either "pop" under the examiner's fingers (B, C), or be manipulated into the scrotum, where it will be palpated by the opposite hand (D).

Complications of incomplete Complications of incomplete descentdescent

• Torsion of testis • Epididymo-orchitis• Associated indirect/interstitial

hernia • Atrophy• Pain• Sterility• Malignancy

MANAGEMENT

TREATMENTTREATMENTA. Hormonal therapy : It is not used as routine treatment. Its main indication is bilateral incomplete descended testis with hypogenitalism and obesity.

*hcG is given 5000 IU. IM daily for 3-5 days OR Inj. Pregnyl 1000 IU. Twice weekly

untill testis descent (for not more than 10 wks and it should never be repeated)

Orally -Methylestosterone 5mg/day for 1 month.

B. Surgical treatment : 1. Orchidopexy An Orchidopexy is used to repair an Undescended

testicle in childhood. An incision is made into the abdomen, the site of the Undescended testicle, and another is made in the scrotum (A). The testis is detached from surrounding tissues (B) and pulled out of the abdominal incision attached to the spermatic cord (C). The testis is then pulled down into the scrotum (D) and stitched into place (E).

AftercareAftercare • If pt. has an uncomplicated Orchidopexy, he can

usually go home the same day. Usually prescribe a pain medication for the first few days after the procedure.

• After the child returns home, he should not bathe until the day after surgery. In addition, he should not ride a bicycle, climb trees, or do anything else that requires straddling for two or three weeks. An older boy should avoid sports or rough games that might result in injury to the genitals until he has a post-surgical checkup.

• Most surgeons will schedule the child for a checkup one or two weeks after the Orchidopexy, with a second checkup three months later.

2. Orchidectomy :It is only advocated when opposite

testis is normal. The indication are--After puberty-when incompletely descended testis

cannot be brought down to scrotum.

3. Orchidocelioplasty : it means abdominal replacement of

testis. This is only indicated when the other testis has been removed previously and this cannot be brought down to scrotum.

-it preserves internal secretions of testis and

-testis is protected from trauma.