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TRANSCRIPT
Dr. Hassaan Ali 2014
Testicular Maldescentcases discussion
Gad Hassaan Ali AhmedAssistant lecturer of urology and Andrology
Dr. Hassaan Ali 2014
Dr. Hassaan Ali 2014
Case no.1Male infant 6 months old came to outpatient clinic by her mother , she notes that he has abnormal external genitals in the form of empty hemi scrotum .
Dr. Hassaan Ali 2014
Dr. Hassaan Ali 2014
would you like to ask the mother any questions before examine the infant ?
Predisposing factors prematurity, birth weight ,
small for gestational age, twinning,
maternal exposure to estrogens in the first trimester, Time of presentation .
Dr. Hassaan Ali 2014
How to examine this infant?
Dr. Hassaan Ali 2014
How to examine this infant?the patient needs to be warm, relaxed and in frog leg position. The state of the scrotum is important .Presence or absence of features like hypoplasticity ,bifidity, rugae,
transposition ,hypospadias and chordee should be noted .Serial examinations may be required .
Dr. Hassaan Ali 2014
what did you find?
Dr. Hassaan Ali 2014
what did you find?1-unilateral palpable undescended testis without associated
genital anomalies .2-unilateral non palpable testis without associated genital
anomalies.3-UDT with associated genital anomalies.
Dr. Hassaan Ali 2014
What investigationEuropean Association of Urology Guidelines Physical examination is the only method of differentiating
palpable and non-palpable testes .There is no benefit from ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI) or angiograph
Diagnostic laparoscopy
is the only reliable examination to confirm or exclude
an intra-abdominal, inguinal and absent/vanishing testis
Dr. Hassaan Ali 2014
Management 1 -Hormonal Therapy effectiveness less than 20%
HCG stimulates Leydig cells directly to produce testosterone , The schedule is 1500 IU/m2 given by intramuscular injection
twice a week for 4 weeks. doses not exceeding 15,000 IU .GnRH stimulates the pituitary to release LH and thereby
promote testicular production of testosterone .in a dosage of 1.2 mg/day divided into three dosages per day for 4 weeks using a nasal spray .
Dr. Hassaan Ali 2014
ManagementStandard Orchidopexy for inguinal testes .
Laparoscopic exploration that will determine whether there is a testis, or not
and if it can be brought down in one or two steps
Dr. Hassaan Ali 2014
If we see this child in age of 6yrs old, what the lines of treatment?
European Association of Urology Guidelines
Remove an intra-abdominal testis in a boy > 10 years witha normal contralateral testis .
A one-stage or two-stage Fowler-Stephens procedure can be performed in a bilateral intra-abdominal testes or in a boy < 10years .
Microvascular auto-transplantation has a 90% testicular survival rate, but requires very skillful and experienced surgical techniques.
Dr. Hassaan Ali 2014
If you see this child in age of 18 years old?Orchiectomy is typically reserved for post pubescent males with a contralateral normally descended testis
Case no.3Male infant 6 months old came to outpatient clinic by his father
due to empty scrotum since birth .
Dr. Hassaan Ali 2014
Dr. Hassaan Ali 2014
What are you looking for on clinical examination?
Location of the both testes.Penile size.Urethral abnormality.Scrotal condition.
Dr. Hassaan Ali 2014
Location of the both testes.
Bilateral inguinal testis.left inguinal and right NPT.Bilateral NPT.Bilateral NPT with other congenital anomalies.
Dr. Hassaan Ali 2014
Investigation For bilateral NPT.
-Is this child a boy? Karyotype ;-Are the testes present? human chorionic gonadotrophin
(HCG) test/anti-Müllerian hormone (AMH)/follicle-stimulating hormone-luteinizing hormone (FSH-LH)
-Where are the testes? Laparoscopy: one- or two-stage orchidopexy
Dr. Hassaan Ali 2014
Medical ttt.HCG stimulates Leydig cells directly to produce testosterone ,GnRH stimulates the pituitary to release LH and thereby.
Dr. Hassaan Ali 2014
Surgical Bilateral inguinal testis.
standard orchiopexy in tow cessation
left inguinal and right NPT
orchiopexy first then laproscopy left standard
Dr. Hassaan Ali 2014
SurgicalBilateral NPT.Diagnostic laparoscopy.one-stage or two-stage Fowler-Stephens procedure can be performed .
Dr. Hassaan Ali 2014
If this child come in adult age.
Dr. Hassaan Ali 2014
Why we should treat undescended testes ?
1 .To increase likelihood of fertility
2 .Facilitation of testicular examination for cancer
3 .Correction of the associated persistent processus vaginalis. This is found in 90% of the cases.
4 .To prevent testicular torsion.5 .Prevent trauma. The undescended testis is more likely to be
pressed against the iliac bone.6 .Reduce the psychological trauma associated with an empty
scrotum.
Dr. Hassaan Ali 2014
THANK YOU