Abnormalities Of The Testis And Scrotum Ahmed Al-Sayyad - PowerPoint PPT Presentation

Loading...

PPT – Abnormalities Of The Testis And Scrotum Ahmed Al-Sayyad PowerPoint presentation | free to download - id: 6ee170-YWE2Z



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Abnormalities Of The Testis And Scrotum Ahmed Al-Sayyad

Description:

Abnormalities Of The Testis And Scrotum Ahmed Al-Sayyad Embryology Testicular differentiation is initiated in the 7th week of gestation by the SRY gene At 4 to 6 ... – PowerPoint PPT presentation

Number of Views:125
Avg rating:3.0/5.0
Slides: 35
Provided by: edus78
Learn more at: http://www.kau.edu.sa
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Abnormalities Of The Testis And Scrotum Ahmed Al-Sayyad


1
Abnormalities Of The Testis And
Scrotum Ahmed Al-Sayyad
2
Embryology
  • Testicular differentiation is initiated in the
    7th week of gestation by the SRY gene
  • At 4 to 6 weeks gestation, the genital ridges
    organize. This is followed by migration of
    primordial germ cells
  • At 7 to 8 weeks both sertoli and leydig cells
    have developed

3
Embryology
  • During the 8th week, the fetal testis begins to
    secrete testosterone and MIS independent of
    pituitary hormonal regulation
  • MIS is secreted by the Sertoli cells and causes
    degeneration of the müllerian structures after
    the 8th week of gestation
  • The gubernaculum appears at the 7th week of
    embryologic development where its cranial aspect
    envelops the cauda epididymis and lower pole of
    the testis and extends caudally into the inguinal
    canal, where it maintains a firm attachment

4
Cryptorchidism
  • 3 of full-term male newborns and 30.3 incidence
    in premature infants
  • More prevalent among preterm, small-for-gestationa
    l-age, low-birth-weight, and twin neonates
  • Approximately 70 to 77 of cryptorchid testes
    will spontaneously descend by 3 months of age
  • By 1 year of age, the incidence of cryptorchidism
    declines to about 1 and remains constant
    throughout adulthood

5
Descent Factors
  • Hormonal androgens,MIS,estrogen,descendin
  • Gubernaculum
  • GFN and CGRP
  • Epididymis
  • Intra-abdominal pressure

6
Terminology
  • Undescended
  • Ascended
  • Gliding
  • Retractile
  • Ectopic

7
Nonpalpable testis
  • Intra-abdominal
  • Vanishing
  • Atrophic
  • Missed on examination
  • Bilateral nonpalpable work-up

8
Consequences of Cryptorchidism
  • Infertility
  • Neoplasia
  • Hernia
  • Torsion
  • Trauma
  • Cosmetic

9
Work-UP
  • Maternal history including the use of gestational
    steroids, Perinatal history, including
    documentation of a scrotal examination at
    birth,PMH,PSH,FH
  • Examine in a warm room,supine,squatting etc
  • Look for genital abnormalities,scrotal
    size,contralateral hypertrophy

10
Investigations
  • Hormones
  • US
  • CT
  • MRI
  • Laparoscopy

11
(No Transcript)
12
(No Transcript)
13
Hormonal Therapy
  • HCG or GnRH can be used
  • The lower the pretreatment position the better
    the results
  • Self limiting side effects
  • Overall success rate lt 20
  • Limited indications if any

14
Surgical Intervention
  • When
  • Inguinal orchiopexy
  • Laparoscopic orchiopexy
  • Fowler-Stephens orchiopexy
  • Staged orchiopexy
  • Microvascular autotransplantation

15
Hydrocele
  • Normally, the processus vaginalis is obliterated
    from the internal inguinal ring to the upper
    scrotum, leaving a small potential space in the
    scrotum that partially surrounds the testis
  • Embryologic misadventures may occur and results
    in (hydrocele, hydrocele of the cord, and
    communicating hydrocele).

16
Simple Hydrocele
  • Simple (scrotal) hydrocele is an accumulation of
    fluid within the tunica vaginalis
  • Results from persistence of or delayed closure of
    the processus vaginalis
  • Commonly seen at birth, frequently bilateral, may
    be quite large. They transilluminate and may seem
    quite tense but not painful
  • Most resolve during the first 2 years of life
  • If surgical repair is elected, an inguinal
    approach should be used

17
Communicating Hydrocele
  • Persistence of the processus vaginalis which
    allows peritoneal fluid to communicate with the
    scrotum
  • The classic description is that of a hydrocele
    that changes in size
  • It can be compressible during examination
  • All should be fixed using an inguinal approach
  • Do it bilateral if patient got VP shunt or on
    peritoneal dialysis

18
Hydrocele of the cord
  • Segmental closure of the processus, which leaves
    a loculated hydrocele of the cord
  • Presents as a painless groin mass which is mobile
    and transilluminates
  • Inguinal exploration and high ligation is
    curative

19
(No Transcript)
20
Acute Scrotum
21
Differential Diagnosis
  • Torsion testis
  • Torsion appendix testis
  • Torsion appendix epididymis
  • Epididymo-orchitis
  • Hernia
  • Trauma
  • Vasculitis
  • Dermatological

22
Testicular Torsion
  • True surgical emergency of the highest order
  • Irreversible ischemic injury may begin as soon as
    4 hours after occlusion of the cord
  • Intravaginal torsion, result from lack of normal
    fixation of the testis and epididymis to the
    fascial and muscular coverings that surround the
    cord
  • This creates an abnormally mobile testis that
    hangs freely within the tunical space (a
    "bell-clapper deformity")

23
Testicular Torsion
  • Happens in any age but most commonly in
    prepubertal males
  • Presentation Pain,N\V,Poor appetite,previous
    episodes
  • ExaminationSwelling,Tenderness,High
    riding,transverse orientation,Loss of cremasteric
    reflex

24
Testicular Torsion
  • Doppler US may help in the diagnosis
  • Manual detorsion may be attempted in ER
  • Scrotal exploration is mandatory
  • Detorte the affected testis and pex the other
    side while waiting for the testis to pink up
  • If the testis is still alive pex it , if not do
    an orchiectomy

25
(No Transcript)
26
(No Transcript)
27
Intermittent Torsion
  • Recurrent episodes of acute, self-limited scrotal
    pain
  • Normal physical examination will be found
    in-between
  • If the suspicion is strong , elective scrotal
    exploration and bilateral orchiopexy should be
    performed

28
Prenatal testicular torsion
  • Extravaginal torsion
  • Presents at birth as a hard,nontender testis
    fixed to the scrotal skin which is usually
    discolored
  • Doppler US may help in the diagnosis
  • Management is controversial observation Vs
    exploration

29
Torsion Appendix Testis
  • presentation is extremely variable, from an
    insidious onset of scrotal discomfort to an acute
    presentation identical to torsion testis
  • ExamTenderness or mass in the upper pole,Blue
    dot sign,cremasteric reflex usually present
  • Doppler US may help in diagnosis
  • Managementconservative,pain meds,limit activity

30
Epididymitis
  • Rare in pediatrics
  • Presentationpain,swelling,erethyma,LUTS,fever,
  • urethral discharge,STDs
  • Investigationspyuria, bacteriuria, positive
    urine culture, increased flow on doppler
  • IV Abx given if systematically ill then oral for
    total of 10-14 days
  • Screening US usually indicated
  • ? VCUG

31
Varicocele
  • Dilated and tortuous veins of the pampiniform
    plexus
  • Found in approximately 15 of male adolescents,
    with a marked left-sided predominance
  • Etiologyincreased venous pressure in the left
    renal vein, incompetent valves of the internal
    spermatic vein

32
varicocele
  • Unilateral varicocele may affect testicular
    function bilaterally
  • Toxic effect of varicocele may manifest as
    testicular growth failure, semen abnormalities,
    Leydig cell dysfunction, and histologic changes
  • Possible mechanismsreflux of adrenal
    metabolites, hyperthermia, hypoxia, local
    testicular hormonal imbalance, and
    intratesticular hyperperfusion injury

33
varicocele
  • Presentationasymptomatic,pain,scrotal
    mass,infertility,atrophy
  • Grading on physical examination
  • Obtain scrotal US
  • Treat if there is loss of volume (gt 2 mls or gt
    20)

34
Treatment Alternatives
  • Inguinal Ligation and Subinguinal Ligation
  • Retroperitoneal and Laparoscopic Ligation
  • Transvenous Occlusion
  • Complicationshydrocele,recurrence,testicular
    atrophy
About PowerShow.com