Testes - Paediatrics

Testes

Undescended testis

·        = Cryptorchidism

·        Descent complete in 96% at birth, in 99% at 3 months 

·        Premature will have ­rate of undescended testis (5% at 1 year)

·        Two types:

o   Arrest of descent: at internal or external ring, or at scrotal neck

o   Ectopic: outside of the line of descent

·        May present with a hernia

·        Surgical correction at about 12 months

·        Sequalae of non-descent:

o   20 times risk of malignancy

o   ?Impact on fertility (due to ?higher temperature impairs spermatogenesis) 

o   If don‟t bring them down they may end up over the pubic ramus ® very uncomfortable sex!

No testis

·        If bilateral undescended testis and hypospadias ® ambiguous genitalia ® urgent referral

·        Torsion in utero ® no testis 

·        No testis = anorchia.  Maybe no kidney on that side Þ check

Retractile Testis

·        Normally in scrotum but retracts upwards during examination

·        Testis normal size

·        Follow-up 2 yearly

·        Surgery unnecessary.  Will drop into scrotum at puberty

Hydrocele

·        Fluid collection between the layers of the tunica vaginalis secondary to trauma, infection or idiopathic. Implies a patent process vaginalis

·        May be bigger in the evening than in the morning

·        Transluminates well, is non-tender and non-reducible 

·        Herniotomy if not resolved by age 2. 50% disappear in first year. Remove tunica vaginalis ® removes potential space 

·        Predisposes to hernia