Urogenital Tract

Abnormalities
dr. Indra Jaya SpU
Department of Urology Arifin Achmad General Hospital

dr.indrajaya.spu@gmail.com

Undecende
d Testis
(CRYPTORCHIDISM)
SKDI 2

Testis

Thetesticleis the malegonad

The primary functions is to produce
sperm
androgens (testosterone)

Temperature Regulation
The testes work best
at temperatures slightly less than core

body temperature.
Thespermatogenesisis less efficient at
lower and higher temperatures.
This is presumably why the testes are
located outside the body.

Embryonic Development
Around fourth week ante-natally, the gonadal rudiments

are presentadjacent to the developing kidneys.

Testes follow the "path of descent" from

Lower pole of kidney in the retro-peritoneum

Internal ring

Inguinal canal

Scrotum

In most cases (97% full-term, 70% preterm), both testes

are normally descended by birth.

In most of the cases, only one testis fails to descend

What is Maldescended Testicle?

It consists of following conditions.

Undescended Testicles
Ectopic Testicles
Retractile Testicle

Clinical Classification
Palpable
Non-Palpable
Abdominal
Atrophy
Absent

DIAGNOSIS

 For Bilateral Non-palpable UDT

Diagnostic and therapeutic Laparoscopy

HCG Challenge test (presence of testicular tissue)

In cases suspected to have disorder of sexual

differentiation

Karyotyping

Hormone levels: FSH, LH, Testosterone

USG: Presence of Uterus

Micro-phallus: Hypopituitarism: Kallamanns Syndrome

Role of imaging studies like

Sonography, CT Scan?
Are not recommended :
they are not 100 % specific or sensitive
they dont change the plan of

management
Often confuses parents when the

imaging findings dont match to the

operative findings

Palpable UDT Management

It needs open orchiopexy
Some of the undescended testis descends on its

own in first 2-3 months

If it does not descent in first few months then it

is unlikely to do so
At present the surgery is advocated at the age of

six months
If surgery is delayed then the function of testis

gets affected due to higher temperature in

abdomen and chronic trauma to the testicle

Retractile Testis
Testis at rest is located in the scrotum
However, with stimulus it ascends in

the inguinal area

Usually they dont need any treatment

Non-Palpable UDT
Management
This patients should be subjected to

laparoscopy around the age of six

months
Depending upon the findings on

laparoscopy further management is

carried out

If not operated patient can

have
decrease in the function of the testis
higher incidence of malignancy
late detection of malignancy
70 % incidence of associated patent processus

vaginalis
higher incidence of torsion
increased incidence of injury
psychological issues

Cancer in UDT

Incidence of malignancy in the undescended testis

1 in 80 with a unilateral undescended testis

1 in 40 to 1 in 50 for bilateral undescended testes.

The peak age for this tumor is 1545 yr.

The most common tumor developing in an UDT is a seminoma

(65%)

in contrast, after orchiopexy, seminomas represent only 30% of

tumors.

Self examination of testis after orchiopexy

Cancer developing in an intra-abdominal testis: late

detection

Recent data: that orchiopexy performed before

puberty resulted in a significantly reduced risk of
testicular cancer

Fertility after Orchiopexy

Unilateral UDT: Same as any other couple

Bilateral UDT: More than 80 %

Testicular
Torsion

SKDI 2

Testicular Torsion
General Consideration :
Ischemic urologic emergency
Typical sudden onset of pain
May have intermittent torsion & pain

NORMAL
TORSION

Epidemiology :
Bimodal Peak
Neonatal period
Age 12 18 years
Unilateral (left side more

common)
Usually preceding physical

exertion or trauma but may

be spontaneus

The tunica vaginalis does not

completely surround the testis
and epididymis, which are
attached to the posterior
scrotal wall .
Bell-clapper anomaly. The
tunica vaginalis completely
surrounds the testis,
epididymis,and part of the
spermatic cord, predisposing to
torsion.
Intravaginal torsion. Bellclapper anomaly with complete
torsion of the spermatic cord,
compromising the blood supply to
the testis.
Extravaginal torsion in a
neonate. Tunica vaginalis is in

Signs & Symptoms

Acute severe testicular pain (affected side)
Testis is tender, swollen and lies higher and in

transverse position (compared to other side)

Absence of cremasteric reflex

Nausea & Vomiting
Palpation may feel the twisted cord
Pain is increase or no improvement by raising

the testis (Prehns Sign)

blue dot sign

Clinical tender "blue dot sign

Torsion of testicular appendage

Treatment
Immediate urologic consultation
Prepare patient for the OR
Doppler ultrasound or Radionuclide

scintigraphy if it will not delay surgery

Surgical detorsion / orchiectomy (non-viable

testicle)

Prognosis
Less than 6 hours salvage rate is

excellent
Beyond 6 hours salvage rate become

worse
After 48 hours salvage rate is zero

Varikokel

SKDI 2