0 Cryptorchidism is the absence of one or both testicles in the scrotum.
0 Cryptorchidism may be due to one of four reasons. Anorchid, retractile testis, ectopic testis, undescended testis
Anorchid
It is the name given to the congenital absence of the testis and is unilateral in 80% of the cases.
Since androgenic stimulation of the fetal testis provides the development of the male external genitalia, the external genitalia in bilateral anorchids have a female appearance.
The only way to distinguish anorchid from a palpable undescended testis is surgically a. demonstrating that the spermatica terminates blindly.
Anorchids cannot be judged on the basis of any imaging method.
Ectopic testis
• Testicular ectopia is the placement of the testis in a different place instead of the scrotum after passing through the inguinal canal and exiting the external ring by following the normal descent path.
• Ectopic testis; It can be located in the suprapubic region, perineum, inner thigh, dorsum of the penis or in the opposite scrotum.
• Repositioning the testis to its normal intrascrotal position surgically constitutes the principle of treatment (orchiopexy).
Retractile testis
The cremaster muscle is more developed in children than in adults.
Therefore, the cremasteric reflex, which occurs with stimulation of the thigh, perineum or cold effect, is more pronounced in children.
This reflex causes the testicle to be pulled up with the mentioned stimuli.
On examination, the testis cannot be found in the scrotum.
However, the testis, which can be palpated in the high scrotal position, in the superficial inguinal pouch or in the inguinal canal, can be lowered to its normal place by stroking.
There is no indication for treatment even in retractile testicles that retract up when released. It resolves spontaneously until adolescence.
Undescended testis
• Testes have not descended into the scrotum in 25% of premature babies and approximately 3% of term babies.
• However, when the same children are re-examined at the end of the first year, it is seen that 5% of premature babies and only 0.5% of those born at term still have undescended testicles unilaterally or bilaterally.
• Undescended testis is a little more common on the right, since the left testis descended into the scrotum earlier embryologically.
• The event is bilateral in up to 15% of all undescended testicles. It is frequently seen with severe congenital anomalies, especially bilateral undescended testis, anencephaly, and abdominal wall defects.
• The undescended testis can be located in an intra-abdominal, intracanalicular or high scrotal position, or it can be located under the skin called the superficial inguinal pouch, above the external oblique muscle, as in 75% of the cases.
Diagnosis
In cases where one or both testicles are not palpable in the scoria, retractile testis and ectopic testis should be differentiated from undescended testis by using the features listed above.
It is not possible to distinguish anorchids by physical examination, since surgical exploration is required for the definitive diagnosis of anorchids, it is not necessary to make a differential diagnosis with an undescended testis before surgery.
Treatment
Surgical treatment is essential in the undescended testis, the operation should be performed after the end of the first age and before the second age is completed.
The use of human chorionic gonadotropin or gonadotropin releasing hormone in conjunction with and in addition to surgery is a generally accepted method.
The aim of surgical treatment is to lower the testis to its normal scrotal position in one or sometimes two sessions.
When dysgenetic and atrophic testicular tissue is encountered, it is more appropriate to perform an orchiectomy instead of lowering it.
Testicular Torsion
0 Testicular torsion occurs when the testis rotates in the tunica vaginalis (intravaginal torsion) or, above, when the spermatic cord rotates around itself with all its elements (extravaginal torsion).
0 The first type is much more common and occurs in prepubertal children. Basic pathology in both : It is the disruption of the blood flow of a.spermatica interna.
0 Testicular torsion is most often confused with orchiepididymitis, and should be treated very quickly, as time wasting for differential diagnosis would result in loss of the testis.
0 Doppler ultrasonographic flow measurement and testicular scintigraphy (99mtc) are very useful methods in differential diagnosis, showing decreased blood flow in testicular torsion and increased blood flow in orchitis and epididymitis.
0 However, if the implementation of these methods will take more than an hour, it is more appropriate to take the child directly to surgery.
0 If it will take more than a few hours for the child to reach a surgical center, manual detorsion may be attempted.
0 Testicular atrophy occurs, which is directly proportional to the duration and severity of torsion, long after detorsion is achieved by surgical intervention or external manipulation.
