Urogenital Tract

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

dr.indrajaya.spu@gmail.com
S
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. Bell-

clapper 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