abnormalities of the testes and scrotum
Post on 06-Jul-2018
226 Views
Preview:
TRANSCRIPT
-
8/17/2019 Abnormalities of the Testes and Scrotum
1/34
Abnormalities Of The Testis And Scrotum
Ahmed Al-Sayyad
-
8/17/2019 Abnormalities of the Testes and Scrotum
2/34
Embryology
Testicular differentiation is initiated in the 7th
week of gestation by the SRY gene
At 4 to weeks! gestation" the genital ridgesorgani#e$ This is followed by migration of
%rimordial germ cells
At 7 to & weeks! both sertoli and leydig cells ha'e
de'elo%ed
-
8/17/2019 Abnormalities of the Testes and Scrotum
3/34
Embryology
(uring the &th week" the fetal testis begins to secretetestosterone and )*S inde%endent of %ituitary hormonalregulation
)*S is secreted by the Sertoli cells and causesdegeneration of the m+llerian structures after the &th weekof gestation
The gubernaculum a%%ears at the 7th week of embryologic
de'elo%ment where its cranial as%ect en'elo%s the caudae%ididymis and lower %ole of the testis and e,tendscaudally into the inguinal canal" where it maintains a firmattachment
-
8/17/2019 Abnormalities of the Testes and Scrotum
4/34
ry%torchidism
./ of full-term male newborns and .0$./ incidence in
%remature infants
)ore %re'alent among %reterm" small-for-gestational-age"
low-birth-weight" and twin neonates
A%%ro,imately 70/ to 77/ of cry%torchid testes will
s%ontaneously descend by . months of age
1y 2 year of age" the incidence of cry%torchidism declinesto about 2/ and remains constant throughout adulthood
-
8/17/2019 Abnormalities of the Testes and Scrotum
5/34
(escent 3actors
ormonal5 androgens")*S"estrogen"descendin
6ubernaculum
63 and 6R8
E%ididymis
*ntra-abdominal %ressure
-
8/17/2019 Abnormalities of the Testes and Scrotum
6/34
Terminology
9ndescended
Ascended
6liding
Retractile
Ecto%ic
-
8/17/2019 Abnormalities of the Testes and Scrotum
7/34
on%al%able testis
*ntra-abdominal
:anishing
Atro%hic
)issed on e,amination
1ilateral non%al%able work-u%
-
8/17/2019 Abnormalities of the Testes and Scrotum
8/34
onse;uences of ry%torchidism
*nfertility
eo%lasia
ernia
Torsion
Trauma
osmetic
-
8/17/2019 Abnormalities of the Testes and Scrotum
9/34
-
8/17/2019 Abnormalities of the Testes and Scrotum
10/34
*n'estigations
ormones
9S
T
)R*
=a%arosco%y
-
8/17/2019 Abnormalities of the Testes and Scrotum
11/34
-
8/17/2019 Abnormalities of the Testes and Scrotum
12/34
-
8/17/2019 Abnormalities of the Testes and Scrotum
13/34
ormonal Thera%y
6 or 6nR can be used
The lower the %retreatment %osition the better the
results Self limiting side effects
O'erall success rate > ?0/
=imited indications if any
-
8/17/2019 Abnormalities of the Testes and Scrotum
14/34
Surgical *nter'ention
-
8/17/2019 Abnormalities of the Testes and Scrotum
15/34
ydrocele
ormally" the %rocessus 'aginalis is obliterated
from the internal inguinal ring to the u%%er
scrotum" lea'ing a small %otential s%ace in thescrotum that %artially surrounds the testis
Embryologic misad'entures may occur and results
in @hydrocele" hydrocele of the cord" and
communicating hydrocele$
-
8/17/2019 Abnormalities of the Testes and Scrotum
16/34
Sim%le ydrocele
Sim%le @scrotal hydrocele is an accumulation of fluid
within the tunica 'aginalis
Results from %ersistence of or delayed closure of the
%rocessus 'aginalis
ommonly seen at birth" fre;uently bilateral" may be ;uite
large$ They transilluminate and may seem ;uite tense but
not %ainful
)ost resol'e during the first ? years of life
*f surgical re%air is elected" an inguinal a%%roach should be
used
-
8/17/2019 Abnormalities of the Testes and Scrotum
17/34
ommunicating ydrocele
8ersistence of the %rocessus 'aginalis whichallows %eritoneal fluid to communicate with thescrotum
The classic descri%tion is that of a hydrocele thatchanges in si#e
*t can be com%ressible during e,amination
All should be fi,ed using an inguinal a%%roach (o it bilateral if %atient got :8 shunt or on
%eritoneal dialysis
-
8/17/2019 Abnormalities of the Testes and Scrotum
18/34
ydrocele of the cord
Segmental closure of the %rocessus" which lea'es
a loculated hydrocele of the cord
8resents as a %ainless groin mass which is mobileand transilluminates
*nguinal e,%loration and high ligation is curati'e
-
8/17/2019 Abnormalities of the Testes and Scrotum
19/34
-
8/17/2019 Abnormalities of the Testes and Scrotum
20/34
Acute Scrotum
-
8/17/2019 Abnormalities of the Testes and Scrotum
21/34
(ifferential (iagnosis
Torsion testis
Torsion a%%endi, testis
Torsion a%%endi, e%ididymis E%ididymo-orchitis
ernia
Trauma :asculitis
(ermatological
-
8/17/2019 Abnormalities of the Testes and Scrotum
22/34
Testicular Torsion
True surgical emergency of the highest order
*rre'ersible ischemic inBury may begin as soon as
4 hours after occlusion of the cord *ntra'aginal torsion" result from lack of normal
fi,ation of the testis and e%ididymis to the fascialand muscular co'erings that surround the cord
This creates an abnormally mobile testis thathangs freely within the tunical s%ace @a Cbell-cla%%er deformityC
-
8/17/2019 Abnormalities of the Testes and Scrotum
23/34
Testicular Torsion
a%%ens in any age but most commonly in
%re%ubertal males
8resentation5 8ain"D:"8oor a%%etite"%re'iouse%isodes
E,amination5Swelling"Tenderness"igh
riding"trans'erse orientation"=oss of cremasteric
refle,
-
8/17/2019 Abnormalities of the Testes and Scrotum
24/34
Testicular Torsion
(o%%ler 9S may hel% in the diagnosis
)anual detorsion may be attem%ted in ER
Scrotal e,%loration is mandatory (etorte the affected testis and %e, the other side
while waiting for the testis to %ink u%
*f the testis is still ali'e %e, it " if not do anorchiectomy
-
8/17/2019 Abnormalities of the Testes and Scrotum
25/34
-
8/17/2019 Abnormalities of the Testes and Scrotum
26/34
-
8/17/2019 Abnormalities of the Testes and Scrotum
27/34
*ntermittent Torsion
Recurrent e%isodes of acute" self-limited scrotal
%ain
ormal %hysical e,amination will be found in- between
*f the sus%icion is strong " electi'e scrotal
e,%loration and bilateral orchio%e,y should be
%erformed
-
8/17/2019 Abnormalities of the Testes and Scrotum
28/34
-
8/17/2019 Abnormalities of the Testes and Scrotum
29/34
Torsion A%%endi, Testis
%resentation is e,tremely 'ariable" from an
insidious onset of scrotal discomfort to an acute
%resentation identical to torsion testis E,am5Tenderness or mass in the u%%er %ole"1lue
dot sign"cremasteric refle, usually %resent
(o%%ler 9S may hel% in diagnosis
)anagement5conser'ati'e"%ain meds"limit acti'ity
-
8/17/2019 Abnormalities of the Testes and Scrotum
30/34
E%ididymitis
Rare in %ediatrics
8resentation5%ain"swelling"erethyma"=9TS"fe'er"
urethral discharge"ST(s *n'estigations5%yuria" bacteriuria" %ositi'e urine
culture" increased flow on do%%ler
*: Ab, gi'en if systematically ill then oral for
total of 20-24 days Screening 9S usually indicated
:96
-
8/17/2019 Abnormalities of the Testes and Scrotum
31/34
:aricocele
(ilated and tortuous 'eins of the %am%iniform
%le,us
3ound in a%%ro,imately 2F/ of male adolescents"with a marked left-sided %redominance
Etiology5increased 'enous %ressure in the left
renal 'ein" incom%etent 'al'es of the internal
s%ermatic 'ein
-
8/17/2019 Abnormalities of the Testes and Scrotum
32/34
'aricocele
9nilateral 'aricocele may affect testicular function
bilaterally
To,ic effect of 'aricocele may manifest as testicular
growth failure" semen abnormalities" =eydig cell
dysfunction" and histologic changes
8ossible mechanisms5reflu, of adrenal metabolites"
hy%erthermia" hy%o,ia" local testicular hormonal
imbalance" and intratesticular hy%er%erfusion inBury
-
8/17/2019 Abnormalities of the Testes and Scrotum
33/34
'aricocele
8resentation5asym%tomatic"%ain"scrotal
mass"infertility"atro%hy
6rading on %hysical e,amination Obtain scrotal 9S
Treat if there is loss of 'olume @G ? mls or G ?0/
-
8/17/2019 Abnormalities of the Testes and Scrotum
34/34
Treatment Alternati'es
*nguinal =igation and Subinguinal =igation
Retro%eritoneal and =a%arosco%ic =igation
Trans'enous Occlusion om%lications5hydrocele"recurrence"testicular
atro%hy
top related