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Testicular Maldescent - Coggle Diagram
Testicular Maldescent
Complications:
Reduced Fertility: Germ cell deficiency leading to reduced fertility, attributed to exposure to higher temperatures in the abdomen.
Increased Risk of Testicular Germ Cell Tumors: Relative risk increases, especially with intraabdominal testes.
Psychological Problems at Puberty: Potential psychological issues during puberty due to anatomical differences.
Increased Risk of Testicular Torsion: Undescended testes are more susceptible to torsion and infarction.
Inguinal Hernias: Association with inguinal hernias, with an increased risk of strangulation.
Incidence
Approximately 3% of term male infants; up to 30% in premature/low birth weight (<2.5 kg) male infants.
Majority descends within the first few months, reducing incidence to 1% at 1 year.
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After 3-4 months, spontaneous descent is rare.
Classification
True UDT:
Arrested along normal descent path (intraabdominal, intracanalicular, or prescrotal).
Ectopic UDT:
Deviated from normal descent path (superficial inguinal region, perineum, femoral triangle, penopubic area, contralateral hemiscrotum).
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Investigation
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Imaging:
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Ultrasound may be considered for non-palpable cases, offering a detailed view of the testicular location and blood flow.
Embryology
Development:
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Coelomic cavity behind the peritoneum, below developing kidneys.
Timeline:
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6 weeks: Primordial germ cells migrate, differentiate into gonocytes (controlled by SRY gene).
7-8 weeks: Sertoli cells secrete MIS, causing regression of Müllerian derivatives and gubernaculum enlargement.
9 weeks: Leydig cells secrete testosterone, inducing differentiation of Wolffian ducts, masculinization of external genitalia, and regression of cranial suspensory ligament.
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Clinical features
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Palpation:
Bimanual Examination:
The first maneuver involves moving the fingers from the iliac crest along the inguinal canal towards the scrotum.
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Scrotal Examination:
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In cases of monorchia (single testis), compensatory hypertrophy may occur.
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