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Bedah Anak 3 - UDT

1) An undescended testis is one that fails to descend into the scrotum and can occur on the right, left, or both sides. 2) Types of undescended testis include lumbar, iliac, inguinal, and retractile or scrotal testes. Complications include torsion, infection, atrophy, and increased risk of infertility or cancer. 3) Treatment options include hormone therapy in some cases, orchidopexy surgery which is usually performed before age 5, and orchidectomy in some situations. Proper evaluation and management can help address risks.

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Ivan D P Sunardi
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65 views19 pages

Bedah Anak 3 - UDT

1) An undescended testis is one that fails to descend into the scrotum and can occur on the right, left, or both sides. 2) Types of undescended testis include lumbar, iliac, inguinal, and retractile or scrotal testes. Complications include torsion, infection, atrophy, and increased risk of infertility or cancer. 3) Treatment options include hormone therapy in some cases, orchidopexy surgery which is usually performed before age 5, and orchidectomy in some situations. Proper evaluation and management can help address risks.

Uploaded by

Ivan D P Sunardi
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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Undescended

testis
Ivan Sunardi
Michael raktion
Yulius Chietera

Paediatric Surgery Division

1
Introduction

An undescended testis is one which has filed to descend to the


scrotum & is retained at any point along the normal path of descend

Right side: 50%

Left side: 30%

Bilateral: 20%
• cryptorchidism

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3
•A, 5th week Testis begins
its primary descent; kidney
ascends.
•B, 8th-9th weeks. Kidney
reaches adult position.
•C, 7th month, Testis at
internal inguinal ring;
gubernaculum (in inguinal
fold) thickens and shortens.
•D, Postnatal life.

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Types of undescended testis

Lumbar testis

Iliac testis: testis remains just deep to the deep inguinal ring

Inguinal: testis is in the inguinal canal

At the superficial inguinal ring

Scrotal testis:
• the testis lies in the upper part of the scrotum

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• Scrotal testis:
– The testis lies in the upper
part of the scrotum
Undescended – Also known as a retractile
testis
testis – Normal scrotal sac & testis
– The testis can be brought
down

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Symptoms

• Underdeveloped
scrotum
• Infertility
Undescended • Indirect inguinal hernia
testis:

Signs

• Empty scrotum

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Torsion of the testis

Epididymo- orchitis
Undescended
testis: Atrophy
complications
Sterility

Malignancy
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Hormone therapy

Orchidopexy
Undescended
testis:
management Orchidectomy

Laparoscopic surgery

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Not used routinely

Undescended
Indications:
testis:
hormone • When the surgeon is not sure whether
the case is one of retractile testis or not
therapy • Bilateral incomplete descended testis
associated with hypogenitalism &
obesity

The hormone mostly used is


human chorionic gonadotrophin

13
Treatment of choice

Undescended
testis:
orchidopexy Usually should be done by the
age of 5 years but it is
unnecessary to do this
operation before completion
of second birthday of the child

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Ectopic
testis The testis fails to descend into
the scrotum & is deviated from
its normal path of descent

15
Position of the ectopic testis

• Superficial inguinal pouch


• Pubopenile ectopia
• Perineal ectopia
• Crural or femoral ectopia
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Comparison between ectopic &
undescended testis
Undescended testis Ectopic testis
• The testis is arrested in its normal path of • The testis deviates from its normal path of
descent descent
• Usually undeveloped • Fully developed testis
• Undeveloped & empty scrotum on the • Empty but usually fully developed scrotum
affected side
• Shorter length of spermatic cord
• Longer length of spermatic cord
• Poor spermatogenesis after 6 yrs • Spermatogenesis is perfect
• Usually associated with indirect inguinal • Never associated with indirect inguinal
hernia hernia
• Treatment: surgery & HT • Treatment: basically surgical
• Associated with a number of complications • Complications: liability to injury

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• Preterm and maternal history, including the
Workup use of gestational steroids
•    Perinatal history, including documentation of
a scrotal examination at birth
•    The child's medical and previous surgical
history
•    Family history of cryptorchidism or
syndromes
All boys with nonpalpable testes and normal
serum gonadotropin levels must undergo
surgical exploration regardless of the
results of the hCG stimulation test.

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