Cryptorchidism
Undescended testis
MC disorder of sexual differentiation in boys
Cryptorchidism
Testicular descent occurs when
7-8m AOG
___% of premature male infants have undescended testis
30%
Majority of undescended testes descend spontaneously when
During the first 3 months of life
If the testis has not descended by ___ it will remain undescended
4 months
T/F Risk of germ cell malignancy in an undescended testis is 2-4x higher than in the general population
T
T/F Risk of germ cell malignancy in bilateral undescended testes is higher than with a unilateral undescended testis
T
MC tumor developing in an undescended testis in an adolescent or adult
Seminoma (65%)
T/F Contralateral testicular hypertrophy is 100% diagnostic that a testis is absent
F, not 100% but is a soft sign
Congenital undescended testis should be treated surgically not later than
9-15 mos of age
Hormonal treatment is INFREQUENTLY used for undescended testis but what hormone may stimulate testicular descent
HCG, stimulates Leydig cell production of testosterone or LHRH
Torsion is the MCC of testicular pain in boys of what age
22 yrs and older
Torsion is uncommon in what age group
Before 10y/o
Torsion is caused by
Redundant tunica vaginalis resulting in inadequate fixation of the testis (bell clapper deformity)
Within ___ hours, absent of blood flow to the testis, irreversible loss of spermatogenesis can occur
4-6
Testicular torsion can be differentiated from incarcerated since ___ is absent with torsion
Swelling in the inguinal area
T/F Cremasteric reflex is nearly always absent with torsion
T
T/F Manual detorsion may be attempted with testicular torsion
T, if pain duration is <4-6 hours
Treatment for testicular torsion
Prompt surgical exploration and detorsion
If the testis is explored within ___, up to 90% of the gonads survivce
6 hours of torsion
T/F Fertility is reduced in men with a history of spermatic cord torsion in adolescence, irrespective of whether detorsion or orchiectomy is performed
T
MCC of testicular pain in boys 2-10y/o
Torsion of appendix testis (rare in adolescents
Varicocele is a congenital condition in which there is an abnormal dilation of the
Pampiniform plexus
MC and virtually the only surgically correctable cause of subfertility in men
Varicocele
Varicocele that might indicate an abdominal or retroperitoneal mass
Boy <10 OR located on the right
T/F Varicocele is typically a PAINLESS paratesticular mass
T
Described as a bag of worms
Varicocele
Grades of varicocele
Examined with the boy standing: Gr 1 palpable only with valsalva, Gr 2 palpable without valsalva but is not visible on inspection, Gr 3 visible with inspection
Gole of varicocelectomy
Maximize chances of fertility
Hydrocele is accumulation of fluid in the
Tunica vaginalis
T/F in most cases, varicocele is noncommunicating
T, procesus was obliterated during development
T/F Fluid of hydrocele disappears spontaneously by what age
1y/o
If there is a persistently patent processus, how does the hydrocele present as
Becomes progressively larger during the day and small in the morning
Long-term risk of a communicating hydrocele
Development of an inguinal hernia
Confirms the fluid-filled nature of the hydrocele
Transillumination of the scrotum