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Treatment of testicular maldescent - Coggle Diagram
Treatment of testicular maldescent
Timing of Treatment:
Orchidopexy, the surgical fixation of the testis, is generally recommended around
12
months of age.
Earlier intervention (around
6
months) may be considered in specific cases, such as bilateral UDT or intraabdominal testes.
In cases associated with inguinal hernia, surgery is performed
as soon as possible
to prevent potential complications like strangulation.
Nonpalpable UDT (Unilateral):
Laparoscopy: Preferred Approach
Diagnostic Laparoscopy:
Vasculature Exploration: Assessment of vasculature to determine further steps.
Options Based on Findings: Different options based on the location and viability of the testis.
Surgical
Depending on the feasibility of mobilization.
One-stage orchidopexy
when testes lies in caudal to iliac vessel
long enough to allow tension free mobilization
Shehata two-stage orchidopexy
Laproscopic
gubernalculum released
Placed in tension to allow spermatic chord stretch for 3-6 month
Fowler-Stephen technique
First stage
Ligation of testicular blood vessel to make testes dependant on artery of the vas
Second stage
6 months later: division of ablated testicular vessel pedicle and mobilization
Microvascular orchidopexy
Postoperative Care: Monitoring for complications and ensuring proper healing.
Nonpalpable UDT (Bilateral):
Serum Gonadotropins and Testosterone:
Assess serum gonadotropins (FSH, LH) and testosterone levels.
Baseline levels help determine the presence of viable testicular tissue.
Baseline gonadotropin
Increased
Anorchia
Normal
hCG stimulation test
Laporoscopy +- Exploration
Surgical Management:
Bilateral Cases: Consideration of different options based on the ease of orchiopexy.
Unilateral Fixation Followed by Contralateral: Fixation of one side first, with the contralateral side fixed 6 - 12 months later.
Bilateral One-Stage or Two-Stage Orchiopexies: Options depending on the practitioner's assessment of outcomes.
contralateral side fixed 6-12 months later
Specialized Techniques:
Microvascular Orchiopexy: Infrequently used due to the need for special instrumentation and microsurgical expertise.
Palpable UDT (Unilateral or Bilateral):
Mainstay of Therapy: Orchidopexy
Orchidopexy involves surgically fixing the testis in the scrotum.
Surgical Approaches:
Two-Incision Approach: Utilizes both inguinal and scrotal incisions for access.
Single-Incision High Scrotal Approach: Alternative approach for orchidopexy.
Techniques:
Subdartos Pouch: Creation of a subdartos pouch during surgery.
Patent Processus Vaginalis: Attention to the patent processus vaginalis during the procedure.
Postoperative Care: Monitoring for complications, such as hematoma or infection.