undescended Tistes

introduction The Prenatal ultrasonography shows no testicular descent before 28 weeks, other than transabdominal movement to the internal inguinal ring

Transinguinal migration, thought to be under hormonal control, occurs from weeks 28-40, usually resulting in a scrotal testis by the end of a full term of gestation. Transinguinal migration, thought to be under hormonal control, occurs from weeks 28-40, usually resulting in a scrotal testis by the end of a full term of gestation. The appropriate time for treatment is when the individual is aged approximately 6 months.

E MEDICINE This age limit has decreased over the recent decades and is based on: (1) the rarity of spontaneous descent after age after age 6 months. (2) the possible salvage of improved fertility by earlier intervention. The choice of initial treatment is a reflection of both physician and patient preference

CURRENT The operation is indicated after months since degenerative changes begin to take place in these testis that may impair the spermatogenesis and lead malignant transformation in additionally the cryptorchid testes are more susceptible to trauma and torsion.

O’neill the timing of surgery remains controversial. Some studies suggesting that delayed orchidopexy late in childhood is associated with good prognosis whereas others show poor results.

Studies showing the early degeneration of the germ cell in the first 6 th to 12 th through to microscopic atrophy in school-age children all suggest that the undesceded testes under go to progressive degeneration after birth. Although the evidence that early surgery prevents this degeneration sequence is not yet available in humans, it is shown in all animal studies.

For some years, orchidopexy has been recommended in second Y of life,but it is now my practice to recommend orchidopexy at 6months. This is because first signs of damage to the testes are identified at about 6 months age.

In pediatric surgical center it is quite reasonable to perform orchidopexy in the 2 nd six months of life; however in center with less experience in small children surgery between 18monthes and 2y may be safer

In my clinic recommend routine examination of all boys at birth with repeat examination at 3 months in those children in whom one or both testes were not descended at birth. If the testis remains undescended at 3month the child is best referred for orchidipexy at 6 to12months of life or in the second y.

When the testes descended spontaneously in the first 3 months such children best to observed every few years to ensure that they do not develop acquired undescended testes later in child hood.

Children presenting with concomitant inguinal hernia should have immediate orchidopexy done at the same time that the inguinal herniorraphy is pre formed This is much safer than delaying the orchidopexy after herniotomy because re – exploration of the inguinal canal in this circumstance has a higher risk of damage to vas and the vessels.