Empty Scrotum

Empty scrotum
Supervised by
Dr.Saber M. Waheeb
Definition
Cryptochidism is the absence of one

or both testes from the scrotum
Normal fetal testicular development

and descent
The testes begin as an immigration of
primordial germ cells into testicular cords
along the genital ridge in the abdomen of
the early embryo .
The testes remain high in the abdomen until

the 7th month of gestation, when they move
from the abdomen through the inguinal canals
into the two sides of the scrotum.
It has been proposed that movement occurs
in two phases, under control of somewhat
different factors
The first phase

movement across the abdomen to the
entrance of the inguinal canal appears
controlled (or at least greatly influenced) by
anti-mllerian hormone (AMH.)
The second phase, in which the testes move

through the inguinal canal into the scrotum, is
dependent on androgens
( most importantly testosterone .)
In many infants with inguinal testes, further

descent of the testes into the scrotum occurs
in the first 6 months of life. This is attributed
to the postnatal surge of gonadotropins and
testosterone that normally occurs between
the first and fourth months of life.
The tissue in undescended testes becomes

more markedly abnormal ("degenerates") in
microscopic appearance between 2 and 4
years after birth .
There is some evidence that early orchiopexy
reduces this degeneration.
Epidemiology
The most common congenital anomaly of the
male genitalia.
There is a higher incidence in premature
babies (up to .)30%
It affects almost 1% of all full-term male
infants at the age of 1 year.
Unilateral cryptorchidism is four times more
likely than bilateral
1* Prematurity
2* Low birth weight
3* environmental chemical
4* Environmental risk factors

5* Familial
6* Genetic
7* Iatrogenic
Causes:
1-Arrested testis:
1-abdominal :
*lumber fossa
*iliac fossa
2-extraabdominal :
*inguinal canal (commonest)
*near pubic tubercle
2-ectopic testis:
LOCKWOOD theory
Sites of ectopic testis:

*superficial inguinal
pouch( commonest )
*femoral
*penile
*perineal
3-asending testis:
4-Atrophied testis:
*history of normal descend .

*unilateral hidden
impalpable testis.
*contra lateral oversized
testis
*equal well developed
scroutum halves.
5-testicular agenesis :
rare
6-Associated with other

abnormalities:
Prune belly syndrome
* HISTORY
Physical examination
* Examination should take place while the child
is supine and in a cross-legged position, and cover the following steps:
* Imaging
or ultrasound ..
* Abdominal and pelvic ultrasonography may be required if intersexuality is suspected.

* US and CT scan are much less accurate in showing intra-abdominal testes.and..does not
add any benefit to differentiating between palpable and non-palpable testes.
* Diagnostic laparoscopy :
is the only way to confirm or rule out an intra-abdominal, inguinal or absent/vanishing testis
(non-palpable testis).
*A
karyotype
can confirm or exclude forms of dysgenetic primary hypogonadism,
such as Klinefelter syndrome or mixed gonadal dysgenesis.

.*.Hormone
levels {human chorionic gonadotropin}
The main goals of hormonal or surgical treatment are :

1- to allow for a normal anatomic position of the testicle
2- the preservation of fertility
3- hormonal production and the diagnosis of potential testicular malignancies.
4- correction of associated hernias
5- prevention of testicular torsion.
Orchiopexy should be considered after 4 months of life, as the rate of descent
diminishes considerably after this point.
In patients who are not candidates for surgical intervention.

hCG or LH-releasing hormones (LHRH) are mainly used.
The approach chosen is determined by the position of the testis and the surgeon's
expertise.
The palpable testis can be approached from a scrotal, sub-inguinal, inguinal, or
supra-inguinal approach.
The non-palpable testis can be approached using an inguinal, supra-inguinal, or
laparoscopic approach.
1. Look for the testis

2. Divide all attachments, including the gubernaculum, the cremasteric fibers, and
the lateral spermatic fascia.
3. Identify the patent processus vaginalis and separate it from the cord structures,
and perform a high ligation; be careful not to trap the vas or vessels.
4. Place the testis in a subdartos pouch.
1. Look for the testis

2. Divide all attachments, including the
gubernaculum, the cremasteric fibers, and the
lateral spermatic fascia.
3. Identify the patent processus vaginalis and
separate it from the cord structures, and
perform a high ligation; be careful not to trap
the vas or vessels.
4. Place the testis in a subdartos pouch.
Diagnostic laparoscopy versus inguinal exploration.
The Fowler-Stephens principle involves dividing the testicular vessels to allow the
blood supply to the vas deferens to keep the undescended testis viable. The testicular
vessels should be divided away from the testis.
Testicular auto-transplantation can be performed by transecting the testicular vessels
and by performing a micro-vascular anastomosis to the inferior epigastric vessels
An undescended testicle isn't in a cooler environment. This might increase the

risk of complications later in life. These complications include:
Fertility problems
Testicular cancer
Other complications related to the abnormal location of the undescended testicle

include:
1. Trauma
If a testicle is located in the groin, it may be damaged from pressure

against the pubic bone.
2. Inguinal hernia
Inguinal hernia
3. Testicular torsion

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Empty scrotum

Cryptochidism is the absence of one

Normal fetal testicular development

The testes remain high in the abdomen until

The first phase

The second phase, in which the testes move

In many infants with inguinal testes, further

The tissue in undescended testes becomes

4* Environmental risk factors

Sites of ectopic testis:

*history of normal descend .

6-Associated with other

Prune belly syndrome

* Examination should take place while the child

is supine and in a cross-legged position, and cover the following steps:

* Abdominal and pelvic ultrasonography may be required if intersexuality is suspected.

can confirm or exclude forms of dysgenetic primary hypogonadism,

such as Klinefelter syndrome or mixed gonadal dysgenesis.

levels {human chorionic gonadotropin}

The main goals of hormonal or surgical treatment are :

In patients who are not candidates for surgical intervention.

1. Look for the testis

1. Look for the testis

Diagnostic laparoscopy versus inguinal exploration.

An undescended testicle isn't in a cooler environment. This might increase the

Other complications related to the abnormal location of the undescended testicle

If a testicle is located in the groin, it may be damaged from pressure

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