2. Aetiology and pathological features
∗ Rare,except a/w mumps
∗ Blood-borne infection
∗ Surgical procedure on the lower urinary tract,e.g. TUR
∗ Organism: Neisseria gonorrhoeae, Escherichia coli and
Chlamydia. In young man, the commonest is
Chlamydia
∗ Tuberculosis
3. Clinical features
∗ Preceding Hx of an operation or of dysuria, frequency
and heamaturia
∗ Acute pain in scrotum,swelling
∗ Epididymis:acutely tender and enlarged(although it
maybe difficult to differentiate from the equally
tender testis)
∗ Overlying redness and oedema maybe present
4. Investigation
∗ FBC: leucocytosis
∗ Blood culture: helpful to direct antibiotic treatment
∗ Urinalysis: pyuria, organism maybe revealed by
culture
∗ Aspiration of the epididymis
∗ USG: increased blood flow
5. Management
∗ Bed rest,scrotal elevation
∗ Tetracycline or erthromycin
∗ Other antiobiotic refer to culture
∗ Partner should also be investigated and treated
7. Epidemiology
∗ Both testes are undescend in 30% of premature
infants
∗ Term:3%
∗ One year:1%
∗ Spontaneous descent after one year is rare
8. Aetiology
∗ Failure of migration along the normal line of descent
∗ Ectopic testis:testicle deviates away from the line and
lie in front of the penis in the superficial inguinal
pouch,in the perineum or in the thigh.(reason
unknown)
9. Risk factor
∗ Prematurity
∗ Low birth weight
∗ Twin gestation
∗ Down syndrome(fetus) or other chromosomal abnormality
∗ Gestational diabetes mellitus
∗ Prenatal alcohol exposure
∗ Hormonal abnormalities (fetus)
∗ Toxic exposures in the mother
∗ Mother younger than 20
∗ A family history of undescended testes
10. Clinical features
An empty scrotal sac or hemiscrotum at 1 year
indicates:
Proximal to the external inguinal
ring(undescended)
Truly absent
Retractile-the cremaster muscle reflexly pulls the
organ up towards the inguinal canal
Ectopic
11. Complication
∗ Infertility:inevitable in bilateral and common in
unilateral undescent,frequent in those who are
undescent treated.
∗ Torsion
∗ Trauma
∗ Inguinal hernia
∗ Malignant disease
12. Investigation
∗ USG,CT and laparoscopy
Management
Target is to bring the testicle with its blood supply
into the scrotum as early as possible
Orchidopexy:should be done beyong puberty
Testicular prosthesis can be placed in the scrotum
13. Testicular torsion
1 Epididymis
2 Head of epididymis
3 Lobules of epididymis
4 Body of epididymis
5 Tail of epididymis
6 Duct of epididymis
7 Deferent duct (ductus deferens or vas
deferens)
14. Testicular torsion
∗ Testicular torsion occurs when the spermatic cord(from
which the testicle is suspended) twists, cutting off the
testicle's blood supply(ischemia)
∗ Cause: recognised complication of testicular maldescent
wherein the testis is inadequately affixed to the scrotum
allowing it to move freely on its axis and susceptible to
induced twisting of the cord and its vessels.
∗ Occurs most probably between birth and early adolescence
15. Twist VS Untwist
∗ Twist deprives the organ of its blood supply
∗ If untwist does not take place within 6
hours,ischaemia is irreversible,gangrene develops and
the testis either suppurates or atrophies
16. Presentation & Finding
∗ Acute severe testicular pain(affected side)
∗ Testis is tender,swollen and hang higher up(compared to
other side)
∗ Poorly localized central abdo pain
∗ Vomitting(sometimes)
∗ Scrotal skin become red,hot and edematous in later stage
∗ Palpation may feel the twisted cord
Pain is increase or no improvement by raising the testis
18. Management
∗ Surgical emergency
∗ Non-operative
∗ Maybe possible to de-rotate the testis
∗ Surgical
∗ Failure of non-operative reduction require emergency
operation
∗ The testis is de-rotated and fixed
∗ The gangrenous testis is removed
