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Empty scrotum tutorial

T
Tarig Hassan Hag Ali

1. The testes begin developing in the abdomen around the third month in utero and normally descend into the scrotum between the seventh and ninth months of fetal development. 2. Factors that can affect the descent of the testes include hormonal factors, genetics, premature birth, and the mother's alcohol/cigarette use during pregnancy. 3. Undescended testes occur in approximately 3% of full-term infants and have higher risks of infertility, testicular cancer, and torsion. Evaluation and early surgery are recommended to lower these risks.

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Empty Scrotum Dr Tarig Hassan Tutorial
Where does the testes start to develop? TarigHHagAli
EMPTY SCROTUM TarigHHagAli
TarigHHagAli When does the testes start to develop?
Testes begin to develop inside the ? by the ? month IU, and descend into the scrotum during ? to ? mth of fetal development. Empty Scrotum TarigHHagAli
Iliac fossa 3rd-5th month Deep inguinal ring 7th month Superficial ring 8th month Scrotum 9th month Empty Scrotum TarigHHagAli
Factors which affect descent: Empty Scrotum TarigHHagAli What are the factors which affect descent
Factors which affect descent: 1- shortening of the gubernaculum. 2- hormonal factors:testesterone,HGnh 3- Insulin-Like 3 (INSL3) 4- differential growth of body wall in relation to a relatively immobile gubernaculum. 5- increased intra-abdominal pressure Others??? Empty Scrotum TarigHHagAli Theories
Risk Factors for incomplete descent? Empty Scrotum TarigHHagAli
Risk Factors for incomplete descent? Empty Scrotum TarigHHagAli Premature birth. Low birth weight. Family history. ?? Genetic. Abdominal wall defect. Alcohol use & Cigarette smokingby the mother. Assisted reproduction (IVF) Parents' exposure to toxins??? Pesticides ?? Down syndrome. Gurney Nat Rev Urol. 2017
DESCENT OF THE TESTES Complete by 1 month post birth Tarig H Hag Ali
70% of full term crypto-orchid testes and up to 95% of premature crypto-orchid testes will spontaneously descend by 1year Empty Scrotum TarigHHagAli N B
PRESENTATION 38yrs Mother advice? Newborn 4 month Bilateral impalpable testes. Empty Scrotum 1 TarigHHagAli
Empty Scrotum 1 ? ? ? TarigHHagAli
PRESENTATION 22yrs M. 8 hrs. painful right inguinal swelling. nausea, vomiting. O/E: tender Rt. Inguinal swelling. Rt empty scrotum. Investigations. Empty Scrotum 2 TarigHHagAli
Exploration surgically 2 TarigHHagAli ? ? ?
PRESENTATION 24 yrs M, vague RIF pain?? for 2 mths. Right iliac fossa mass. Investigations. Empty Scrotum 3 TarigHHagAli
PRESENTATION Surgical Exploration. Seminoma. Empty Scrotum 3 TarigHHagAli
Empty Scrotum
Palpable testes. Non-palpable testes. Empty Scrotum Undescended testes. 95% Ectopic testes. <5% Retractile testes. Atrophic / Vanishing ascending testes. <2% Anorchia. TarigHHagAli
UNDESCENDED TESTES How common?? Right > Left, 25% bilateral. Empty Scrotum TarigHHagAli
UNDESCENDED TESTES Incidence: 3 % in full term infant. 1 % by one year. 30% in premature infant. Empty Scrotum TarigHHagAli
UNDESCENDED TESTES Right > Left, 25% bilateral. Empty Scrotum TarigHHagAli
AETIOLOGY: Several theories: Reduced intra-abdominal pressure. cong abdominal wall defects, hernias. Abnormality of the gubernaculum. Endocrine abnormality HCGH, Testesterone, LH. Familial, chromosomal, multifactorial. Empty Scrotum TarigHHagAli
LOCATION Palpable or non-palpable Empty Scrotum TarigHHagAli
COMPLICATIONS Higher incidence of: Cancer. 30 times increased risk. (NOT AFFECTED BY ORCHIOPEXY). Infertility. 70% in bilateral. Testicular torsion. Trauma. Empty Scrotum TarigHHagAli
COMPLICATIONS Associations Inguinal hernia: patent PV. Hypospadias. Psychological effects. Empty Scrotum TarigHHagAli
EVALUATION History. Prematurity, FH. Physical examination: - warm room, quiet - child. - check Wt. for GA. Scrotal development. Penile development +? Contralateral hypertrophy or atrophy. Empty Scrotum TarigHHagAli
UNDESCENDED TESTES for non-palpable -Ultrasonography. -CT-scan. -MRI. Empty Scrotum Investigations TarigHHagAli
UNDESCENDED TESTES Laparoscopy: Diagnosis + management Empty Scrotum TarigHHagAli
UNDESCENDED TESTES Management: Rationale: limiting complications. Empty Scrotum TarigHHagAli
UNDESCENDED TESTES Management: Hormonal therapy: ??? Empty Scrotum TarigHHagAli
UNDESCENDED TESTES Management: Surgery: Operative treatment: WHEN ??? Empty Scrotum TarigHHagAli
UNDESCENDED TESTES Procedure: orchidopexy Empty Scrotum TarigHHagAli
UNDESCENDED TESTES Early orchidopexy may improve fertility No evidence that it reduces risk of malignancy Empty Scrotum TarigHHagAli
ECTOPIC TESTES Less < 5 % descended properly from the abdomen .. but mis-directed outside the external inguinal to an abnormal position. presumably due to an abnormally positioned distal extension of the gubernaculum. function normally. Empty Scrotum TarigHHagAli
Empty Scrotum Incompletely descended Ectopic TarigHHagAli
RETRACTILE TESTES ? Hyperactive cremasteric reflex. normal size & consistency scrotum well developed. remains in scrotum with manipulation. Empty Scrotum TarigHHagAli
ASCENDING TESTES ? - Trauma. - Previous inguinal surgery. Empty Scrotum - Trauma. - Infection. - Previous inguinal surgery. TarigHHagAli

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