Cryptorchidism surgery: Difference between revisions
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== | ==Surgery== | ||
The primary management of cryptorchidism is surgery, called [[orchiopexy]]. It is usually performed in infancy, if inguinal testes have not descended after 4-6 months, often by a [[pediatric urologist]] or pediatric surgeon, but in many communities still by a general [[urologist]] or surgeon. | The primary management of cryptorchidism is surgery, called [[orchiopexy]]. It is usually performed in infancy, if inguinal testes have not descended after 4-6 months, often by a [[pediatric urologist]] or pediatric surgeon, but in many communities still by a general [[urologist]] or surgeon. | ||
When the undescended [[testis]] is in the inguinal canal, hormonal therapy is sometimes attempted and occasionally successful. The most commonly used [[hormone]] therapy is human chorionic [[gonadotropin]]. A series of hCG injections (10 injections over 5 weeks is common) is given and the status of the testis/testes is reassessed at the end. Although many trials have been published, the reported success rates range widely, from roughly 5 to 50%, probably reflecting the varying criteria for distinguishing retractile testes from low [[inguinal]] testes. | When the undescended [[testis]] is in the inguinal canal, hormonal therapy is sometimes attempted and occasionally successful. The most commonly used [[hormone]] therapy is human chorionic [[gonadotropin]]. A series of hCG injections (10 injections over 5 weeks is common) is given and the status of the testis/testes is reassessed at the end. Although many trials have been published, the reported success rates range widely, from roughly 5 to 50%, probably reflecting the varying criteria for distinguishing retractile testes from low [[inguinal]] testes. In cases where the testes are identified preoperatively in the inguinal canal, orchiopexy is often performed as an outpatient and has a very low complication rate. An incision is made over the inguinal canal. The testis with accompanying cord structure and blood supply is exposed, partially separated from the surrounding tissues ("mobilized"), and brought into the [[scrotum]]. It is sutured to the scrotal tissue or enclosed in a "sub[[dartos]] pouch." The associated passage back into the inguinal canal, an [[inguinal hernia]], is closed to prevent re-ascent. | ||
Surgery becomes more complicated if the blood supply is not ample and elastic enough to be stretched into the scrotum. In these cases, the supply may be divided, some vessels sacrificed with expectation of adequate [[collateral circulation]]. In the worst case, the testis must be "auto-transplanted" into the scrotum, with all connecting [[blood vessels]] cut and reconnected ("[[anastomosis|anastomosed]]"). | |||
Surgery becomes more complicated if the blood supply is not ample and elastic enough to be stretched into the scrotum. In these cases, the supply may be divided, some vessels sacrificed with expectation of adequate [[collateral circulation]]. In the worst case, the testis must be " | |||
When the testis is in the abdomen, the first stage of surgery is exploration to locate it, assess its viability, and determine the safest way to maintain or establish the blood supply. Multi-stage surgeries, or auto-transplantation and anastomosis, are more often necessary in these situations. Just as often, intra-abdominal exploration discovers that the testis is non-existent ([[vanishing testes syndrome|"vanished"]]), or dysplastic and not salvageable. | When the testis is in the abdomen, the first stage of surgery is exploration to locate it, assess its viability, and determine the safest way to maintain or establish the blood supply. Multi-stage surgeries, or auto-transplantation and anastomosis, are more often necessary in these situations. Just as often, intra-abdominal exploration discovers that the testis is non-existent ([[vanishing testes syndrome|"vanished"]]), or dysplastic and not salvageable. | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Saumya Easaw, M.B.B.S.[2]
Surgery
The primary management of cryptorchidism is surgery, called orchiopexy. It is usually performed in infancy, if inguinal testes have not descended after 4-6 months, often by a pediatric urologist or pediatric surgeon, but in many communities still by a general urologist or surgeon.
When the undescended testis is in the inguinal canal, hormonal therapy is sometimes attempted and occasionally successful. The most commonly used hormone therapy is human chorionic gonadotropin. A series of hCG injections (10 injections over 5 weeks is common) is given and the status of the testis/testes is reassessed at the end. Although many trials have been published, the reported success rates range widely, from roughly 5 to 50%, probably reflecting the varying criteria for distinguishing retractile testes from low inguinal testes. In cases where the testes are identified preoperatively in the inguinal canal, orchiopexy is often performed as an outpatient and has a very low complication rate. An incision is made over the inguinal canal. The testis with accompanying cord structure and blood supply is exposed, partially separated from the surrounding tissues ("mobilized"), and brought into the scrotum. It is sutured to the scrotal tissue or enclosed in a "subdartos pouch." The associated passage back into the inguinal canal, an inguinal hernia, is closed to prevent re-ascent.
Surgery becomes more complicated if the blood supply is not ample and elastic enough to be stretched into the scrotum. In these cases, the supply may be divided, some vessels sacrificed with expectation of adequate collateral circulation. In the worst case, the testis must be "auto-transplanted" into the scrotum, with all connecting blood vessels cut and reconnected ("anastomosed").
When the testis is in the abdomen, the first stage of surgery is exploration to locate it, assess its viability, and determine the safest way to maintain or establish the blood supply. Multi-stage surgeries, or auto-transplantation and anastomosis, are more often necessary in these situations. Just as often, intra-abdominal exploration discovers that the testis is non-existent ("vanished"), or dysplastic and not salvageable.
The principal major complication of all types of orchiopexy is loss of the blood supply to the testis, resulting in loss of the testis due to ischemicatrophy or fibrosis.
There have been cases where the condition has resolved itself during contact sports, following blunt force to the abdomen. However, this technique is not recommended because the impact sufficient to 'pop' the testicle into place may cause trauma to the abdomen.