Understanding Absent Testis and Undescended Testes
Absent testis and undescended testes in boys can be due to various reasons such as testicular torsion or abnormalities in descent. Learn about the different conditions, diagnostic methods, and treatment options available for these issues in pediatric patients. Understanding the implications and management of testicular abnormalities is crucial for ensuring optimal health outcomes in affected individuals.
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Presentation Transcript
Orri r Ormarsson Barnaskur l knir MD. PhD
Absent testis vascular compromise (eg, prenatal testicular torsion), also known as the "vanishing testis syndrome" or testicular regression syndrome [2]. Boys who have bilaterally absent testes have anorchia. (See "Neonatal testicular torsion", section on 'Prenatal'.) Absent testis An absent testis may be due to agenesis or atrophy secondary to intrauterine Retractile testes position by the cremasteric reflex. These testes can be brought into a dependent scrotal position and will remain there if the cremasteric reflex is overcome (eg, by holding the testis in the scrotum for at least one minute) [4]. (See 'Examination' below.) Retractile testes Retractile testes are normal testes that have been pulled into a suprascrotal Ascending testes then to "ascend" and become undescended (ie, acquired undescended testes) [5-8]. Ascending testes Ascending testes are noted to be in a scrotal position in early childhood and Undescended descent into the scrotum (figure 1). They may remain in the abdominal cavity (picture 2) or they may be palpable in the inguinal canal (intracanalicular) or just outside the external ring (suprascrotal (picture 3)) [3]. Undescended testes testes True undescended testes have stopped short along their normal path of Ectopic testes diverted to an aberrant position [3]. They may be palpable in the superficial inguinal pouch (most common), suprapubic region, femoral canal, perineum (picture 4), or contralateral scrotal compartment (least common) (figure 2). Ectopic testes Ectopic testes descend normally through the external ring but then are
Orsakast af -Agenesis (mydast ekki) -Intrauterin testicular torsio Alltaf ver ur a sta festa absent testes Me fer -Unilat: engin, protesa -Bilat: horm nagj f
Eistu sem voru niri dragast upp Hj 1 rs 10 ra Vegna stutts s strengs?? Me fer : a ger
Eistu sem frast upp og niur (cremaster) algengt fyrstu v. veiks cremasters reflex Ekki aukin h tta torsio, krabbameini, e a minni frj semi Enginn me fer en fylgja eftir
Eistu til staar en -of h tt uppi - undescended - vitlaus um sta - ectopic
Launeista er meal algengustu mefddra galla hj drengjum 3-5% allra n f ddra en 30% fyrirburum 10% bilateral Flest koma ni ur en vi 1 rs aldur sitja um 1% eftir (af llum b rnum)
(A) 2 mn. Eista myndast urogenital ridge (B) 3 m n. Coelomic holi bungar ni ur scrotal b nguna og myndar processus vaginalis (C) 7 m n. Eistun f rast p ng leitt fram af gubernaculum
Ekki vita, allt sem truflar elilegan gang m la! Horm nar skortur Gonadotropin in utero Skortur M llerian inhibiting substance (MIS) Auki estradiol Gubernaculum samdr ttur-ver ur ekki? Opnun processus vaginalis Utana komandi ttir: eiturefni, alk h l, reykinga Erf ir og gen: Insulin-like factor 3 Samfara rum g llum/syndromum: hypospadiasis, n ra herniur, abd. wall defekts, Down s, Prade- Willi, Noonan, Kallmann
Saga Sko un mun CT/MRI
frjsemi Krabbamein Upp sn ningur (torsio testes) verkar Hernia Testosteron (androgen) skortur Sj lfsmynd
Skiptir mli hvenr eista frist (er frt) niur pung og hvort b i eistu eru ofan pungs breytingar eista vi 6-12 m na a aldur -seinka ur roski, og f kkun, germ cells -skemmdir s p plum -f kkun Leydig fruma (<testosteron) -Varanlegt a einhverju leyti Aukin t ni frj semisvanda, s rstaklega ef bilat F rri s frumur, minna motility A ger fyrir 1 rs aldur
Talsvert aukin (4-40x) htta myndun germ-cell krabbameins eista Algengast a birtist milli 15 og 45 ra Tali sk ra 10% alls eistnakrabbameins Intraabdominal eista er 4x l klegra en inguinal eista 10-25% essara tilvika ver a contralateral, e lilega ni urgengnu eista! F rsla eistans pung minnkar essa h ttu a eins l tillega en eykur hins vegar l kindi ess a reifa fyrirfer eista Cryptorchidisma er st rsti h ttu ttur myndunar testicular carcinoma in situ um (8% allra me cancer m. s gu um cryptorchidisma)
Fyrir 1 rs aldur Opinn a ger -um n ra -scrotalt e a parascrotalt Laparoscopi (Fowler-Stephens procedure) Microvascular a ger Horm name fer hCG er nota ( USA). Virkar stundum ef eista er sta sett efst pung e a distalt inguinal canal Tali geta minnka frj semisvanda seinna meir
