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A 1-month-old male infant is brought to the clinic by his mother, who has noticed that both sides of his scrotum appear empty while giving him a bath. She reports no history of trauma or swelling in the scrotal area. There have been no feeding difficulties or signs of systemic illness. The infant was born at term via normal vaginal delivery with no perinatal complications. On examination, both scrotal sacs are found to be underdeveloped and empty. Palpable masses are noted in the inguinal regions bilaterally. The infant is otherwise well, with normal growth and development. At what age should orchidopexy be planned for this patient?
Study Notes
Retractile Testis
- A retractile testis temporarily ascends into the inguinal canal due to an overactive cremasteric reflex.
- Stimulation of the scrotal or thigh skin triggers the cremaster muscle to contract, causing the testis to ascend.
- When the cremaster relaxes, the testis reappears, only to retract again if the scrotal skin is touched.
- A retractile testis is normal in size, unlike an undescended testis.
- A retractile testis can be gently milked from the inguinal region to the base of the scrotum.
- You can distinguish a retractile testis from an undescended testis by attempting to move the testis back into the scrotum - a retractile testis can be gently moved back.
Undescended Testis
- The testis is arrested along its normal path of descent.
- Most commonly found in the inguinal canal.
- Often underdeveloped.
Testicular Descent
- Starts at 3 months of fetal life
- Reaches the scrotum by 9 months.
- Influenced by differential abdominal wall growth, hormonal changes, and the pull of the gubernaculum.
Complications of Undescended Testis
- Indirect Inguinal Hernia - most common.
- Seminoma - most common malignancy.
- Epididymo-orchitis.
- Sterility.
- Torsion.
- Trauma.
Management of Undescended Testis
- Spontaneous descent may occur until 5 months of age.
- Orchidopexy is performed between 6-12 months.
- For preterm babies, orchidopexy is performed later.
- Diagnostic laparoscopy is done to locate the testis followed by orchidopexy if the testis is not palpable.
- If the testis is rudimentary/necrotic/seen with blind ending vessels, orchidectomy or removal of remnants is done.
Types of Orchidopexy
- Fowler Stephens procedure - the vessels are divided and testis is brought down into the scrotum in one or two stages
Differential Diagnoses
- Ectopic Testis: The testis has deviated from its normal path of descent and is located in an abnormal position, most commonly the superficial inguinal pouch.
- Management: Orchidopexy.
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Description
This quiz explores the concepts of retractile and undescended testis, along with the normal process of testicular descent. Understand the physiological mechanisms behind testicular movement and how these conditions can be differentiated. Perfect for medical students and health professionals.
