Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.
Mr. Dinabandhu Barad, MSC TUTOR, SNC,SOA,DTU
CONGENITAL
ANOMALY OF
GENITOURINARY
SYSTEM
Mr. Dinabandhu Barad, MSC TUTOR, SNC,SOA,DTU
BY:
Dinabandhu Barad
MSC TUTOR, SN...
UNDESCENDED TESTIS
Mr. Dinabandhu Barad, MSC TUTOR, SNC,SOA,DTU
DEFINITION
Undescended testis is the failure of one or both testes
to reach the normal position in the scrotal sac through...
INCIDENCE
Cryptorchidism is the most common genital abnormality in boys,
affecting approximately 30% of baby boys born pre...
ETIOLOGICAL FACTORS
• The exact cause of an undescended testicle isn't known.
• A combination of genetics, maternal health...
• Impairment of the hypothalamic pituitary gonadal axis: block in the hormonal
axis to stimulate the testes to descend or ...
HPG AXIS
Mr. Dinabandhu Barad, MSC TUTOR, SNC,SOA,DTU
• Heredity or chromosomal anomalies: absence of one or both testes
• Short spermatic cord and artery mechanically prevent ...
RISK FACTORS
Factors that might increase the risk of undescended testicle in a newborn
include:
• Low birth weight
• Prema...
RISK FACTORS
Factors that might increase the risk of undescended testicle in a newborn
include:
• Conditions of the fetus ...
• Cigarette smoking by the mother or exposure to secondhand smoke
• Obesity in the mother
• Diabetes in the mother — type ...
TESTIS DEVELOPMENT
The most common theories that explain cryptorchidism.
• Shortly after 6 weeks' gestation, the testis-de...
TESTIS DEVELOPMENT
• Around 9 weeks' gestation, Leydig cells start producing testosterone, which
promotes development of t...
SEX DIFFERENTIATION
PATHOGENESIS
At 32–36 wk, the testis, which is anchored at the internal inguinal ring, begins its
process of descent by gu...
Mr. Dinabandhu Barad, MSC TUTOR, SNC,SOA,DTU
THEORIES OF PATHOPHYSIOLOGY OF
CRYPTORCHIDISM
Several potential explanations for the pathophysiology of cryptorchidism hav...
TYPES
• Retractile or pseudo cryptorchidism
• Palpable
• Non palpable
• Ectopic
Mr. Dinabandhu Barad, MSC TUTOR, SNC,SOA,D...
TYPES
Retractile or pseudo cryptorchidism:
• This is NOT an undescended testicle but is often mistaken for one.
• It is ca...
Palpable (80%):
• In this type, (also called prepubic or inguinal) the testicle is located anywhere
from just above the sc...
Mr. Dinabandhu Barad, MSC TUTOR, SNC,SOA,DTU
CLINICAL FEATURES
• A nonpalpable testis (unable to feel on examination) is the most common
symptom of cryptorchidism.
• H...
DIAGNOSIS
Mr. Dinabandhu Barad, MSC TUTOR, SNC,SOA,DTU
PHYSICAL EXAMINATION
• The patient must be examined in a warm, relaxed environment.
• Closely observing the scrotum before...
PHYSICAL EXAMINATION
• The best method of evaluating for an undescended testis is to start palpating at
level of the ingui...
Mr. Dinabandhu Barad, MSC TUTOR, SNC,SOA,DTU
Mr. Dinabandhu Barad, MSC TUTOR, SNC,SOA,DTU
LABORATORY STUDIES
• Routine laboratory workup is not indicated with unilateral cryptorchidism.
• Patients with bilateral ...
LABORATORY STUDIES
The evaluation should include chromosomal analysis and measurement of
• 17-hydroxylase progesterone
• t...
LABORATORY STUDIES
• Anorchia can be confirmed by means of hormonal stimulation with human
chorionic gonadotropin (hCG), w...
LABORATORY STUDIES
• Another marker of testicular function is müllerian-inhibiting substance (MIS; also
known as antimülle...
Imaging studies have little or no role in the diagnosis of cryptorchidism.
USG, computed tomography (CT), magnetic resonan...
Complications of a testicle not being located where it is
supposed to be include:
• Testicular cancer
• Fertility problems...
TREATMENT
• In most cases, the testicle will descend without treatment during the child’s first
year. If this does not occ...
• Having surgery early may prevent damage to the testicles that can cause
infertility.
• An undescended testicle that is f...
Mr. Dinabandhu Barad, MSC TUTOR, SNC,SOA,DTU
Upcoming SlideShare
Loading in …5
×

of

UNDESCENDED TESTIS/CRYPTORCHIDISM(CONGENITAL ANOMALY OF GENITOURINARY SYSTEM) Slide 1 UNDESCENDED TESTIS/CRYPTORCHIDISM(CONGENITAL ANOMALY OF GENITOURINARY SYSTEM) Slide 2 UNDESCENDED TESTIS/CRYPTORCHIDISM(CONGENITAL ANOMALY OF GENITOURINARY SYSTEM) Slide 3 UNDESCENDED TESTIS/CRYPTORCHIDISM(CONGENITAL ANOMALY OF GENITOURINARY SYSTEM) Slide 4 UNDESCENDED TESTIS/CRYPTORCHIDISM(CONGENITAL ANOMALY OF GENITOURINARY SYSTEM) Slide 5 UNDESCENDED TESTIS/CRYPTORCHIDISM(CONGENITAL ANOMALY OF GENITOURINARY SYSTEM) Slide 6 UNDESCENDED TESTIS/CRYPTORCHIDISM(CONGENITAL ANOMALY OF GENITOURINARY SYSTEM) Slide 7 UNDESCENDED TESTIS/CRYPTORCHIDISM(CONGENITAL ANOMALY OF GENITOURINARY SYSTEM) Slide 8 UNDESCENDED TESTIS/CRYPTORCHIDISM(CONGENITAL ANOMALY OF GENITOURINARY SYSTEM) Slide 9 UNDESCENDED TESTIS/CRYPTORCHIDISM(CONGENITAL ANOMALY OF GENITOURINARY SYSTEM) Slide 10 UNDESCENDED TESTIS/CRYPTORCHIDISM(CONGENITAL ANOMALY OF GENITOURINARY SYSTEM) Slide 11 UNDESCENDED TESTIS/CRYPTORCHIDISM(CONGENITAL ANOMALY OF GENITOURINARY SYSTEM) Slide 12 UNDESCENDED TESTIS/CRYPTORCHIDISM(CONGENITAL ANOMALY OF GENITOURINARY SYSTEM) Slide 13 UNDESCENDED TESTIS/CRYPTORCHIDISM(CONGENITAL ANOMALY OF GENITOURINARY SYSTEM) Slide 14 UNDESCENDED TESTIS/CRYPTORCHIDISM(CONGENITAL ANOMALY OF GENITOURINARY SYSTEM) Slide 15 UNDESCENDED TESTIS/CRYPTORCHIDISM(CONGENITAL ANOMALY OF GENITOURINARY SYSTEM) Slide 16 UNDESCENDED TESTIS/CRYPTORCHIDISM(CONGENITAL ANOMALY OF GENITOURINARY SYSTEM) Slide 17 UNDESCENDED TESTIS/CRYPTORCHIDISM(CONGENITAL ANOMALY OF GENITOURINARY SYSTEM) Slide 18 UNDESCENDED TESTIS/CRYPTORCHIDISM(CONGENITAL ANOMALY OF GENITOURINARY SYSTEM) Slide 19 UNDESCENDED TESTIS/CRYPTORCHIDISM(CONGENITAL ANOMALY OF GENITOURINARY SYSTEM) Slide 20 UNDESCENDED TESTIS/CRYPTORCHIDISM(CONGENITAL ANOMALY OF GENITOURINARY SYSTEM) Slide 21 UNDESCENDED TESTIS/CRYPTORCHIDISM(CONGENITAL ANOMALY OF GENITOURINARY SYSTEM) Slide 22 UNDESCENDED TESTIS/CRYPTORCHIDISM(CONGENITAL ANOMALY OF GENITOURINARY SYSTEM) Slide 23 UNDESCENDED TESTIS/CRYPTORCHIDISM(CONGENITAL ANOMALY OF GENITOURINARY SYSTEM) Slide 24 UNDESCENDED TESTIS/CRYPTORCHIDISM(CONGENITAL ANOMALY OF GENITOURINARY SYSTEM) Slide 25 UNDESCENDED TESTIS/CRYPTORCHIDISM(CONGENITAL ANOMALY OF GENITOURINARY SYSTEM) Slide 26 UNDESCENDED TESTIS/CRYPTORCHIDISM(CONGENITAL ANOMALY OF GENITOURINARY SYSTEM) Slide 27 UNDESCENDED TESTIS/CRYPTORCHIDISM(CONGENITAL ANOMALY OF GENITOURINARY SYSTEM) Slide 28 UNDESCENDED TESTIS/CRYPTORCHIDISM(CONGENITAL ANOMALY OF GENITOURINARY SYSTEM) Slide 29 UNDESCENDED TESTIS/CRYPTORCHIDISM(CONGENITAL ANOMALY OF GENITOURINARY SYSTEM) Slide 30 UNDESCENDED TESTIS/CRYPTORCHIDISM(CONGENITAL ANOMALY OF GENITOURINARY SYSTEM) Slide 31 UNDESCENDED TESTIS/CRYPTORCHIDISM(CONGENITAL ANOMALY OF GENITOURINARY SYSTEM) Slide 32 UNDESCENDED TESTIS/CRYPTORCHIDISM(CONGENITAL ANOMALY OF GENITOURINARY SYSTEM) Slide 33 UNDESCENDED TESTIS/CRYPTORCHIDISM(CONGENITAL ANOMALY OF GENITOURINARY SYSTEM) Slide 34 UNDESCENDED TESTIS/CRYPTORCHIDISM(CONGENITAL ANOMALY OF GENITOURINARY SYSTEM) Slide 35 UNDESCENDED TESTIS/CRYPTORCHIDISM(CONGENITAL ANOMALY OF GENITOURINARY SYSTEM) Slide 36 UNDESCENDED TESTIS/CRYPTORCHIDISM(CONGENITAL ANOMALY OF GENITOURINARY SYSTEM) Slide 37
Upcoming SlideShare
What to Upload to SlideShare
Next
Download to read offline and view in fullscreen.

2 Likes

Share

Download to read offline

UNDESCENDED TESTIS/CRYPTORCHIDISM(CONGENITAL ANOMALY OF GENITOURINARY SYSTEM)

Download to read offline

CONGENITAL ANOMALY OF GENITOURINARY SYSTEM, BY MR. DINABANDHU BARAD

Related Books

Free with a 30 day trial from Scribd

See all

Related Audiobooks

Free with a 30 day trial from Scribd

See all

UNDESCENDED TESTIS/CRYPTORCHIDISM(CONGENITAL ANOMALY OF GENITOURINARY SYSTEM)

  1. 1. Mr. Dinabandhu Barad, MSC TUTOR, SNC,SOA,DTU
  2. 2. CONGENITAL ANOMALY OF GENITOURINARY SYSTEM Mr. Dinabandhu Barad, MSC TUTOR, SNC,SOA,DTU BY: Dinabandhu Barad MSC TUTOR, SNC,SOA,DTU
  3. 3. UNDESCENDED TESTIS Mr. Dinabandhu Barad, MSC TUTOR, SNC,SOA,DTU
  4. 4. DEFINITION Undescended testis is the failure of one or both testes to reach the normal position in the scrotal sac through the inguinal canal. Mr. Dinabandhu Barad, MSC TUTOR, SNC,SOA,DTU
  5. 5. INCIDENCE Cryptorchidism is the most common genital abnormality in boys, affecting approximately 30% of baby boys born prematurely and about 4% born at term. Around 1 in 20 male babies born at term also has cryptorchidism. Many of these will become descended in time. However, for around 1 in 70 cases, the testis remains undescended after the child is 1 year old. Mr. Dinabandhu Barad, MSC TUTOR, SNC,SOA,DTU
  6. 6. ETIOLOGICAL FACTORS • The exact cause of an undescended testicle isn't known. • A combination of genetics, maternal health and other environmental factors might disrupt the hormones, physical changes and nerve activity that influence the development of the testicles. Mr. Dinabandhu Barad, MSC TUTOR, SNC,SOA,DTU
  7. 7. • Impairment of the hypothalamic pituitary gonadal axis: block in the hormonal axis to stimulate the testes to descend or the testes may fail to respond o the stimulus due to some inherent defects • Anatomical obstruction: there may be an obstruction in the pathway of descend or failure of intra abdominal pressure to rise Mr. Dinabandhu Barad, MSC TUTOR, SNC,SOA,DTU ETIOLOGICAL FACTORS
  8. 8. HPG AXIS Mr. Dinabandhu Barad, MSC TUTOR, SNC,SOA,DTU
  9. 9. • Heredity or chromosomal anomalies: absence of one or both testes • Short spermatic cord and artery mechanically prevent the descend Mr. Dinabandhu Barad, MSC TUTOR, SNC,SOA,DTU ETIOLOGICAL FACTORS
  10. 10. RISK FACTORS Factors that might increase the risk of undescended testicle in a newborn include: • Low birth weight • Premature birth • Family history of undescended testicle or other problems of genital development Mr. Dinabandhu Barad, MSC TUTOR, SNC,SOA,DTU
  11. 11. RISK FACTORS Factors that might increase the risk of undescended testicle in a newborn include: • Conditions of the fetus that can restrict growth, such as Down syndrome or an abdominal wall defect • Alcohol use by the mother during pregnancy Mr. Dinabandhu Barad, MSC TUTOR, SNC,SOA,DTU
  12. 12. • Cigarette smoking by the mother or exposure to secondhand smoke • Obesity in the mother • Diabetes in the mother — type 1 diabetes, type 2 diabetes or gestational diabetes • Parents' exposure to some pesticides Mr. Dinabandhu Barad, MSC TUTOR, SNC,SOA,DTU RISK FACTORS
  13. 13. TESTIS DEVELOPMENT The most common theories that explain cryptorchidism. • Shortly after 6 weeks' gestation, the testis-determining SRY gene on chromosome Y directly affects the differentiation of the indifferent gonad into a testis. • Around 6-7 weeks' gestation, Sertoli cells develop and secrete müllerian inhibitory substance (MIS; also known as antimüllerian hormone [AMH]), which leads to the regression of the female genital organs. Mr. Dinabandhu Barad, MSC TUTOR, SNC,SOA,DTU
  14. 14. TESTIS DEVELOPMENT • Around 9 weeks' gestation, Leydig cells start producing testosterone, which promotes development of the wolffian duct into portions of the male genital tract. • The testis remains in a retroperitoneal position until 28 weeks' gestation, at which time inguinal descent of the testicle begins. Most testes have completed their descent into the scrotum by 40 weeks' gestation. Mr. Dinabandhu Barad, MSC TUTOR, SNC,SOA,DTU
  15. 15. SEX DIFFERENTIATION
  16. 16. PATHOGENESIS At 32–36 wk, the testis, which is anchored at the internal inguinal ring, begins its process of descent by gubernaculum. The gubernaculum distends the inguinal canal and guides the testis into the scrotum. Following testicular descent, the patent processus vaginalis (hernia sac) normally involutes. Mr. Dinabandhu Barad, MSC TUTOR, SNC,SOA,DTU
  17. 17. Mr. Dinabandhu Barad, MSC TUTOR, SNC,SOA,DTU
  18. 18. THEORIES OF PATHOPHYSIOLOGY OF CRYPTORCHIDISM Several potential explanations for the pathophysiology of cryptorchidism have been proposed, including • Gubernacular abnormalities, • Reduced intra-abdominal pressures, • Intrinsic testicular or epididymal abnormalities • Endocrine abnormalities, • Anatomic anomalies (eg, fibrous bands within the inguinal canal or abnormal arrangement of the cremasteric muscle fibers). Mr. Dinabandhu Barad, MSC TUTOR, SNC,SOA,DTU
  19. 19. TYPES • Retractile or pseudo cryptorchidism • Palpable • Non palpable • Ectopic Mr. Dinabandhu Barad, MSC TUTOR, SNC,SOA,DTU
  20. 20. TYPES Retractile or pseudo cryptorchidism: • This is NOT an undescended testicle but is often mistaken for one. • It is caused byoveractive muscles that pull the testicle(s) out of the scrotum. • In this type the testicles can be placed in the scrotum manually and stay there for a short period of time. • This is a type of normal and does not need treatment. Mr. Dinabandhu Barad, MSC TUTOR, SNC,SOA,DTU
  21. 21. Palpable (80%): • In this type, (also called prepubic or inguinal) the testicle is located anywhere from just above the scrotum to high in the groin. Nonpalpable (15%): • This means the testicle is in the boy’s abdomen or is absent and not felt in the scrotum or inguinal canal. Ectopic (5%): • In this case, the testicle has taken the wrong path and ended in an unusual location in the groin area. Mr. Dinabandhu Barad, MSC TUTOR, SNC,SOA,DTU TYPES
  22. 22. Mr. Dinabandhu Barad, MSC TUTOR, SNC,SOA,DTU
  23. 23. CLINICAL FEATURES • A nonpalpable testis (unable to feel on examination) is the most common symptom of cryptorchidism. • However, each child may experience symptoms differently. • Symptoms of cryptorchidism may resemble other conditions or medical problems. Mr. Dinabandhu Barad, MSC TUTOR, SNC,SOA,DTU
  24. 24. DIAGNOSIS Mr. Dinabandhu Barad, MSC TUTOR, SNC,SOA,DTU
  25. 25. PHYSICAL EXAMINATION • The patient must be examined in a warm, relaxed environment. • Closely observing the scrotum before manipulation is important. • The frog-leg or catcher position may be used to facilitate palpation of the testis. • Determining if the testis is palpable is essential. If the testis is palpable, ascertain whether it can be retracted. Mr. Dinabandhu Barad, MSC TUTOR, SNC,SOA,DTU
  26. 26. PHYSICAL EXAMINATION • The best method of evaluating for an undescended testis is to start palpating at level of the inguinal canal and perform a milking motion down toward the scrotum. • Look for hemiscrotal asymmetry and for contralateral testicular hypertrophy; both are partial indicators of an absent testis. • Examination of potential ectopic sites (eg, penile, femoral, and perineal areas) is important if the testicle cannot be felt in the inguinal area. Mr. Dinabandhu Barad, MSC TUTOR, SNC,SOA,DTU
  27. 27. Mr. Dinabandhu Barad, MSC TUTOR, SNC,SOA,DTU
  28. 28. Mr. Dinabandhu Barad, MSC TUTOR, SNC,SOA,DTU
  29. 29. LABORATORY STUDIES • Routine laboratory workup is not indicated with unilateral cryptorchidism. • Patients with bilateral nonpalpable testis and those with unilateral or bilateral undescended testis associated with hypospadias should undergo evaluation to rule out a disorder of sex development (DSD). Mr. Dinabandhu Barad, MSC TUTOR, SNC,SOA,DTU
  30. 30. LABORATORY STUDIES The evaluation should include chromosomal analysis and measurement of • 17-hydroxylase progesterone • testosterone, luteinizing hormone (LH) • follicle-stimulating hormone (FSH). For bilateral nonpalpable testis, abdominal-pelvic ultrasonography (US) is advisable, mainly to determine if any müllerian structures, such as a uterus, are present. Mr. Dinabandhu Barad, MSC TUTOR, SNC,SOA,DTU
  31. 31. LABORATORY STUDIES • Anorchia can be confirmed by means of hormonal stimulation with human chorionic gonadotropin (hCG), with baseline and poststimulation measurement of LH, FSH, and testosterone hormone levels. (If LH and FSH level rises without testosterone) Mr. Dinabandhu Barad, MSC TUTOR, SNC,SOA,DTU
  32. 32. LABORATORY STUDIES • Another marker of testicular function is müllerian-inhibiting substance (MIS; also known as antimüllerian hormone [AMH]). • MIS levels that exceed 5 ng/mL suggest the presence of testicular tissue and are an indication for exploration. • However, this study is not yet in widespread use, and its applicability to older children remains to be defined. Mr. Dinabandhu Barad, MSC TUTOR, SNC,SOA,DTU
  33. 33. Imaging studies have little or no role in the diagnosis of cryptorchidism. USG, computed tomography (CT), magnetic resonance imaging (MRI), and angiography have been used to detect undescended testes. However, these studies have unacceptable false-positive and false-negative rates. CT exposes the patient to high levels of radiation, and MRI requires sedation or anesthesia; both are costly Mr. Dinabandhu Barad, MSC TUTOR, SNC,SOA,DTU IMAGING STUDIES
  34. 34. Complications of a testicle not being located where it is supposed to be include: • Testicular cancer • Fertility problems • Other complications related to the abnormal location of the undescended testicle include: • Testicular torsion. • Inguinal hernia. Mr. Dinabandhu Barad, MSC TUTOR, SNC,SOA,DTU COMPLICATIONS
  35. 35. TREATMENT • In most cases, the testicle will descend without treatment during the child’s first year. If this does not occur, treatment may include: • Hormone injections (HCG or testosterone) to try to bring the testicle into the scrotum. It also helps in the enlargement of the testis. • Surgery (orchiopexy) to bring the testicle into the scrotum. This is the main treatment. If there is an associated hernia, the herniotomy along with orchidoplexy is indicated. Mr. Dinabandhu Barad, MSC TUTOR, SNC,SOA,DTU
  36. 36. • Having surgery early may prevent damage to the testicles that can cause infertility. • An undescended testicle that is found later in life may need to be removed. This is because the testicle is not likely to function well and could pose a risk for cancer. Mr. Dinabandhu Barad, MSC TUTOR, SNC,SOA,DTU TREATMENT
  37. 37. Mr. Dinabandhu Barad, MSC TUTOR, SNC,SOA,DTU
  • puspanjalijena96

    Oct. 6, 2020
  • Persiskwaku

    Oct. 5, 2020

CONGENITAL ANOMALY OF GENITOURINARY SYSTEM, BY MR. DINABANDHU BARAD

Views

Total views

57

On Slideshare

0

From embeds

0

Number of embeds

0

Actions

Downloads

9

Shares

0

Comments

0

Likes

2

×