UNDESCENDED TESTIS OR CYPTOCHIDISM

DEFINITION
Undescendd testis or Cryptorchidism literally means hidden or obscure testis and generally refers to an undescended or maldescended testis. Cryptorchidism is derived from the Greek words "crypto" (meaning "hidden") and "orchid" (meaning "testicle").

INCIDENCE RATE:
Overall, 3% of full-term male newborns have cryptorchidism, decreasing to 1% in male infants aged 6 months to 1 year. The prevalence of cryptorchidism is 30% in premature male neonates . Internationally, prevalence ranges from 4.3-4.9% at birth to 1-1.5% at age 3 months to 0.8-2.5% at age 9 months. Cryptorchidism is identified in 1.54% of fathers and 6.2% of brothers of patients with cryptorchidism

CAUSES
AT 2 MONTHS 1 Gubernaculum testis 2 Penis 3 Inguinal canal 4 Testis 5 Peritoneal cavity 6 Deferent duct

AT 3 MONTHS

AT 7 MONTHS

AT 9 MONTHS

CONTINUED
Severely premature infants can be born before descent of testes Low birth weight Intra uterine growth retardation A contributing role of environmental chemicals endocrine disruptors that interfere with normal fetal hormone balance has been proposed use of mild painkillers (aspirin, ibuprofen, paracetamol) during pregnancy, especially during the second trimester and if several painkillers were taken simultaneously.

hernia repair or other surgery in the inguinal area resulted in trapping of a testis above the scrotum. Environmental risk factors may include exposure to regular alcohol consumption during pregnancy exposure to pesticides, gestational diabetes, being a twin and being born to pregnant women who drink caffeine (at least 3 drinks per day)

DIAGNOSTIC ASSESSMENT AND INVESTIGATIONS

EXAMINATION OF THE GROIN FOR AN UNDESCENDED TESTICLE IS OFTEN ENHANCED WITH THE USE OF LUBRICATION.

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).

FIGURE 3. (Top) Laparoscopic appearance of a normal right-sided vas deferens and spermatic vessels exiting the internal inguinal ring. Note that the vas deferens and vessels clearly meet at the ring. (Bottom) Here, the vas deferens and vessels do not meet, suggesting that they are blind ending--the characteristic finding of the "vanishing testis."

FIGURE 4A. A low intra-abdominal testicle identified at the level of the internal ring. A laparoscopic orchiopexy maintaining the integrity of the spermatic vessels is possible in this case.

FIGURE 4B. A HIGH TESTICLE, LOCATED WELL ABOVE THE INTERNAL INGUINAL RING.

FIGURE 4C. Testicle managed in two stages, with initial clipping of the spermatic vessels to allow collateral blood supply from the vas deferens to develop more fully.

FOLLOW UP CARE
Long-term issues include infertility and tumorigenesis. After the initial post-operative visits, children should be seen 1 year after surgery to note the location and size of the testes. At puberty, boys should be taught how to perform monthly testicular self-examinations. The threshold for future ultrasound examination. Once the boys reach adulthood, issues regarding fertility must be further explored with a urologist.

PATIENT EDUCATION
Provide health education to the paents that if it is left untreated Testicles don't seem to mature normally when they aren't in the scrotum, so undescended testicles can increase child's risk of developing testicular cancer and infertility later in life if left in place for more than two years, according to the American Academy of Pediatrics. In very rare cases, an undescended testicle can twist, cutting off its own blood supply and causing pain in the groin or scrotum