1. Undescended Testis : Along the normal path, but not reached scrotum. 2. Retractile Testis : Hyperreflexic Cremaster 3. Ectopic Testis : Deviation from normal path of descent Absence of testis in scrotum since birth Hemiscrotum empty, hypoplastic

1. Undescended
Testes
(Cryptochiridsm)
W. P. Rivindu H. Wickramanayake
Group no. 04a
5th Year 1st Semester – 2019 March
Tbilisi State Medical University, Georgia

2. Absence of Testes
1. Undescended Testis : Along the normal path, but not
reached scrotum.
2. Retractile Testis : Hyperreflexic Cremaster
3. Ectopic Testis : Deviation from normal path of descent

3.  Genital ridge – intermediate plate
mesoderm
 Germ cells derived from yolk sac.
Leydig and Sertoli cells from
mesenchyme underlying genital
ridge.
 Vas deferens formed by
mesonephric duct
Embryology

4.  Starts at 8th wk
 Reaches deep Inguinal ring by 3rd month
 Lies dormant upto 6th month
 Traverses Inguinal canal during 7th month
 Reaches Superficial ring by 8th month
 Reaches bottom of scrotum by 9th month
Why descend ?
Descent of Testes

5. Trans abdominal phase – mainly mechanical
- Increasing abdominal pressure
- Differential growth of body wall
- Pull by Gubernaculum
 Trans Inguinal phase – Combination of hormonal
and mechanical factors.
- Testosterone-through CGRP
- Processus Vaginalis
Factors responsible
for the descent

7.  Absence of testis in scrotum
since birth
 Hemiscrotum empty,
hypoplastic
 Testis may or may not be
palpable along the path of
descent.
 70% of UDT are palpable, 30%
non palpable.
Clinical Features

9. Alteration of testicular structure
- Leydigs cells
- Germ cells
Infertility
Inguinal Hernia
Torsion testis
Malignancy
Trauma
Psychological
Pathophysiology

10.  If palpable- no investigations needed
 Unilateral impalpable- no
investigations needed, but USG is
done by many
 Bilateral impalpable- rule out
Intersex if genitalia look abnormal.
Investigations

11.  No surgical intervention till
child is 1yr of age unless there is
associated complication like
hernia or torsion.
 Surgery if testis has
not descended by 1 yr.
Management

12.  Unilateral - Orchidopexy
 Bilateral – Orchidopexy
in the same sitting.
Palpable Testes

13.  30% of all UDT
 45% are intra abdominal
 20% canalicular
 35% vanishing testis
 < 1% anorchia
Impalpable Testes

14.  Blind ending vessels – terminate
procedure
 Vessels exiting internal ring -
Inguinal exploration – orchidopexy /
orchiectomy
 Intra abdominal testis – Fowler
Stephen procedure
Laparascopy

15.  Look for testis / nubbin in the
inguinal canal or blind ending vas
& vessels
 If canal is empty, open the deep
ring and explore retro peritoneum
up to lower pole of kidney
Inguinal
Exploration

16.  Groin incision
 Divide gubernaculum
 Herniotomy
 Divide bands holding the vessels to
lateral abd wall
 Place the testis in extra dartos pouch
Orchidopexy

20.  Communication exists between testicular
artery & artery to vas through small
arterioles in the peritoneal fold between
them.
 If the testicular artery is ligated and this
peritoneal fold kept intact, testis can get
adequate blood supply from these
collaterals.
Fowler Stephen
Procedure

21. Thank You!