57. Etiology, Diagnosis, and Management of the Undescended Testis скачать в хорошем качестве

57. Etiology, Diagnosis, and Management of the Undescended Testis

1. Normal scrotal position has been defined as positioning of the midpoint of the testis at or below the midscrotum. 2. Undescended testis or cryptorchidism is the condition in which the testis is not in a normal scrotal position and may occur u/l or b/l . 3. Testes may be arrested along the normal line of descent or reside in an ectopicnposition outside the ipsilateral inguinal canal. 4. Most absent testes are vanishing or vanished, developing initially but then lost as a result of a vascular accident or torsion unilaterally (monorchia) or, very rarely, bilaterally (anorchia). 5. Agenesis refers to a testis that was never present and, therefore, is associated with ipsilateral müllerian duct persistence. 6. Congenital cryptorchidism refers to a testis that is outside the scrotum at birth. 7. Acquired cryptorchidism is defined as a cryptorchid testis that was documented as scrotal on a previous examination. 8. Recurrent cryptorchidism is defined as a cryptorchid testis that was undescended at birth, descended spontaneously, and is subsequently located outside the scrotum. 9. Secondary cryptorchidism and testicular retraction have been used to describe a testis that is suprascrotal after inguinal hernia repair or as a complication of orchiopexy, respectively. 10. Testicular malposition after hernia repair could be caused by either primary maldescent or postoperative scarring. 11. Retractile testes are scrotal testes that retract easily out of the scrotum but can be manually replaced in a stable scrotal position and remain there at least temporarily until there is recurrent stimulation. Testes that rarely remain in a stable scrotal position (spontaneously or with manipulation) and/or are located at rest in the high scrotum may develop into cases of acquired cryptorchidism on detected on subsequent examination. Sample Q. What is cryptorchidism and how is it classified? Ans. Cryptorchidism, also known as undescended testis, is a common congenital anomaly where one or both testes are not found in their normal scrotal position. Testes can be arrested along their normal descent path or reside in an ectopic position outside the ipsilateral inguinal canal. The condition is classified in several ways: 1. Congenital cryptorchidism refers to a testis that is outside the scrotum at birth. 2. Acquired cryptorchidism is diagnosed when a testis was previously documented as scrotal but is later found to be cryptorchid. This often presents later in childhood (average age 8-11 years) and may be a milder form of congenital cryptorchidism that was initially missed. 3. Recurrent cryptorchidism describes a testis that was undescended at birth, spontaneously descended, and then subsequently reascended outside the scrotum. 4. Absent testes (nonpalpable) are those that never developed (agenesis) or developed but were lost due to a vascular accident or torsion (vanishing/vanished testis or monorchia; rarely anorchia if bilateral). Agenesis is associated with ipsilateral müllerian duct persistence.