Chypt orchidism, or undescended testes, occurs in approximately 10% of mature newborns and 20% of premature infants. The testes normally descend from the abdomen into the scrotum between the 7th and 8th months of gestation. While the exact etiology is unknown, hormonal influences from maternal and fetal hormones are thought to stimulate descent. Surgery is the main treatment and involves mobilizing the testes and bringing it into the scrotum to prevent future issues like torsion or infertility.

1. RCMCH
DR,MEDHAT EL-SAYED
CONSULTANT OF PEDIA-SURGERY
Chypt orchidism

2. Chypt orchidism
Empt y Scrot um.
One of t he most common
pediat ric surgical disorders.
Chypt orchidism occurs in approximat ely
10%mat ure newborns.
premat ure inf ant s 20%.
There is lit t le t o be known about
t he et iology.
Surgery is t he corner st one
of t herapy

3. The t est es originat e in t he
mesonephric ridge on each side
of t he f et al spine.
it is descend Drown downward
Through t he ret roperit oneal Space.
it is get Out t hrough t he abdominal
wall at (7t h
– 8t h mont hs) of
gest at ion.
.
Test icular Embryology

4. Genes - Ovary/Testis Development

5. T. Klonisch et al. Developmental Biology 270 (2004) 1–18
(insulin-like peptide hormone 3)

7. Model for testicular migration
• 1) migration of testis apparently involves two
phases
– Initial stage is transabdominal migration
– Second stage is passage through the
inguinal canal
• 2) A number of hormones are involved in
this
process
– INSL3 (insulin-like peptide hormone 3)
– Testosterone

8. 5
Dart os musde
in f ascia of
t he
Scrot um
Fascia of t he
t riangleFemoral
ligcimentI nguinal
Coll’s f ascia in
t he Perineum
TuberclePubic
= 5 ent opic sit e of t he male descended t est es
+ Transverse oct opi (t o t he ot her scrot al sit e)
Ectopic testes :

9. Testosterone: masculinizing effects on the sensory
genito femoral nerve (GFN) nucleus
In males,
–L1 to L2 of the dorsal root ganglia
–Unilateral trans section of the GFN causes ipsilateral
cryptorchidism
•Sensory branch of the GFN acts via the neurotransmitter
–calcitonin gene-related peptide (CGRP)
–affects gubernacular migration during the inguinoscrotal
phase.
CGRP elicits rhythmic contractions of gubernacula
–stimulates growth and differentiation of neonatal
myogenic cells

10. Hormonal inf luences
mat ernal genadot ropic hormone
+1st
+2nd
+3rd
Maternal Genadotropic hormone
-
+
St imulat e t he pr oduct ion of
Andr ogenic hormones f r om
t he f et al t est is.

11. Figure 2. Spectrum of GnRH-induced LH secretion in
men with GnRH deficiency. LH pulsations are indicated
by asterisks. A, Normal adult male pattern of GnRH
secretion with high amplitude regular LH pulsations
and normal serum testosterone (T), testicular volume
(TV) and sperm count; B, Disordered amplitude pattern
of GnRH secretion in an IHH male, characterized by low
amplitude LH pulsations, low serum T, and
azoospermia; C, Sleep-entrained or developmental
arrest pattern of LH secretion in an IHH male
characterized by relatively low amplitude LH pulsations
clustered during the night-time hours analogous to the
pattern which normally occurs at puberty. Note that the
TV is higher than in the subject with the apulsatile
pattern; D, Apulsatile pattern of GnRH secretion in an
IHH male with complete absence of endogenous LH
pulsations, low serum T, prepubertal TV and
azoospermia.

13. Hormone :
-Failure
St imulat e f et al t est es
t o produce Hor mone
Test icular
r ecept or def ect
Hor monal
st ruct ure
def ect
Male descended
t est
Insufficient Tesicular
response to hCG in
36.5%

14. ??? Why unilat eral (75%)
Undescended is common
Ther e is several ot her f act ors
r at her t han hormonal or
guber naculums Cause.

15. Undescended
testes
Empt y scr ot um
Ret ract ile t est es
is t he t est es which does not descend
int o t he scrot um spont aneously, (wit h
out cord t ract ion or pain)
True surgical pat hology
False
surgical
pat hology
Ect opic t est es
3%-5%
Dysgenet ic or
at rophic t est es
5%
Absent t est es
=int ra abdominal
True and
undecided t est es
=palpable 89%

16. Retractile testes:
Empt y st rat um due t o
Drop to Scrotum
when children
sleep or relaxed
Over action of cremasteric muscle
In adequate gubernaculums attachment
of the testicle to the scrotum.
It is bilateral usually
It will be normal with adolescent

17. impalpable
•Hypo plast ic or Absent t est 8% empt y Scr ot um
- Hor monal
- Torsion
- I nt r a ut erine
- Ext r a ut erine
• Test icular vessel obst ruct ion
Explor at ion is necessar y because t ot al
absence is uncommon.
Terat o gensit y is high.

18. True undescended testes Law :
• The higher t he t est is t he mor e Dysgenet ic,
morphologic f eat ures gonad ar e likely t o be.
• 75 % or mor e is unilat eral.
• Spermat ic ar t er y short er t han nor mal is t he
commonest cause in unilat eral.

19. Bilateral
• hor monal (endocrinology) dist ur bance is common
wit h Bilat er al.
•Anat omic def ect Limit ing descent t he t est is:
- Ex t r ophy of t he bladder .
- Gast orschisis.
- Pr uns belly syndr ne.
- hypospedias.
- I nt er Sex anomalies.

20. Hormonal ttt :
• The hormonal t r eat ment is indicat ed f or :
- Ret ract ile t est .
- Test es down t o t he scrot al neck.
- Bilat er al undescended wit h pr oved
hor monal dist ur bance.
- Bef or e sur ger y.
success rat e
•40%-50% For t he 1st
– 3t h
mont hs af t er
t reat ment .
•10% -5% f or t he 6t h
mont hs af t er t t t .

21. Side effect :
- Syst emic ef f ect .
- Test icular degenerat ion changes due
t o incr ease and decr ease blood supply
in shor t t ime.
f ailur e of t he medical t reat ment

22. Radiologic studies to localize the testis are
currently of very little value.
---CT scan and ultrasonography are associated
with high false-negative rates in the evaluation
of a non-palpable testis and are not
recommended.
---Magnetic resonance angiography has been
reported to have a nearly 100% sensitivity but
requires sedation or anesthesia and is
expensive and may be not cost-effective.
----clinical diagnosis and laparoscopic exploration
are the up date diagnostic and therapeutic.
.

23. Surgery:
•orchiopexy.
•I ndicat ions.
- t o enhance f ert ilit y.
- incidence of t or sion.
- t o repair concomit ant her nia.
- t o prevent t rauma and pain.
- pr ovide easier examinat ion f or
t est icular t umor .
- Psychological ef f ect and
cosmoses.

24. - Mobilizat ion of t he t est icular art er y vein,
vas def er ence t o lower down t he t est es in
t he scr ot um dir ect ly rat her t han
cir cuit ous cour se.
Rational of Surgery:

25. Orchiopexy:

26. testes
gubernaculums
Released gubernaculums
Cord with the hernia sac Short cord
Hernial sac

28. Orchiopexy:

29. Inferior epigastric artery
Floor of the inguinal canal
Retroperitoneal space

30. Long looped vas
Ove-testes
testes

33. Thank you