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EPIDEMIOLOGY
Incidence: premature babies (21%), Cryptorchidism incidence rate:
term infants (4.3%) • Neonates <2500 g: 30.3%
Age 1 year: 0.75-0.8% who remain
• Neonates> 2500 g: 3.4%
cryptorchid
• 12 months old: 1.8%
70-75%: unilateral cryptorchidism,
the rest are bilateral • > 12 months: 0.8%
• Adult: 0.8%
ETIOLOGY
The exact cause of cryptorchidism is unclear. Some related things are:
1. Testicular gubernaculum abnormalities
Decline in the testes is guided by the gubernaculum. A large gubernaculum mass will dilate the
testicle, contraction, involution, and traction and fixation of the scrotum will place the testis in the
scrotal bag. When the thesis has been in the gubernaculum scrotum pouch will be absorbed
(Backhouse, 1966) If this structure is not formed or formed abnormally it will cause testicular
maldesensus.
2. Testicular intrinsic defects : Maldesensus can be caused by gonadal dysgenesis where this
abnormality makes the testes insensitive to the gonadotropin hormone.
3. Deficiency of hormonal / endocrine stimulation
• Inadequate maternal gonadotropin hormone causes incomplete decensus. This clarifies the case of
bilateral cryptorchidism in preterm infants when the development of maternal gonadotropin remains in
low levels until the last 2 weeks of pregnancy.
• High cryptorchidism in preterm is thought to occur due to inadequate HCG stimulation of fetal
testosterone release due to immature Leydig cells and immature hypothalamic-pituitary-testicular axis.
• The defect of the hypothalamic-pituitary-gonadal axis will affect testicular descent. The main hormones
that regulate the testes are LH and FSH which are reproduced by basophilic cells in the anterior pituitary
which are regulated by LHRH. FSH will affect the Sertoli cells, seminiferous tubular epithelium. FSH
levels rise in testicular abnormalities.
4. Genetic / hereditary : malformation syndrome, chromosomal abnormalities
RISK FACTOR
Because the exact cause of cryptorchidism is unclear, we can only detect risk factors,
including:
LBW (less 2500 mg)
Mothers who are exposed to estrogen during the first trimester
Double births (twins 2, twins 3)
Premature birth (gestational age less than 37 weeks)
Fetal underweight
Have a father or sibling with a history of UDT
EMBRIOLOGY
Male genital tract: originates from End of week 7: intracoelomic testes
urogenital ledge.
Month 3:
Medial section: form the genital ledge internal desensus testicles are
located above the pelvis
Weeks 4-5: primitive gonads form Months 8-9:
Week 6: gonad differentiation external desensus testicles
descend to the scrotum
1. cortical persistence: forming an
ovary Internal structure of the testes:
2. medullary development: forming
develops in the 3rd month
External genitalia: arises at week 6
the testes
called genital tubercles (genital
tubercles)
shape the penis in men and the clitoris
on woman
Determined by the Y chromosome or X-
Y interaction
EMBRIOLOGY
Testicular desensus to the scrotum last 3 The process of migration / descent of the
months intrauterine, mostly completed at testes involves 3 stages:
birth 1.Nephric displacement
There are 3 factors that play a role in the When the position of the testes is relatively
decline process testicles: changed, as a result rising mesonephros. At
1. Anti Mullerian hormone (AMH) this stage endocrine factors no role. This
phase is completed in 7 weeks.
2. Intra-abdominal pressure
2.Transabdominal migration
3. Androgen hormone factors
Caused by the growth of the gubernaculum
extraabdominal. In this phase Mullerian
Inhibiting substance has a role.
This phase occurs between weeks 7 and 12
Surgical Therapy : the goal of surgery is to mobilize the testes, adequacy of the
spermatic vasa supply, adequate testicular fixation to the scrotum, and the
accompanying surgical abnormalities such as hernias.
Operation techniques on UDT:
I. Orchydopexy Standard
The principle of orchidopexy includes 3 stages
a. Funiculolysis
b. Transfer of the testes into the scrotum (transposition)
c. Fixation of the testes in the scrotum
II. Stephen Flower Orchidopexy
III. Orchydopexy gradually
COMPLICATIONS
Preoperative
Inguinal hernias : About 90% of UDT sufferers have ipsilateral lateral inguinal
hernias caused by failure of the closure of the processus vaginalis.
Torsion Testicles : The incidence of torsion increases in UDT, presumably
influenced by the dimensions of the testes which increase according to the volume
of the testes.
Testicular trauma : Testicles located in the superficial pubic tubercle are often
affected by trauma.
Malignancy : The incidence of testicular tumors in the normal population is 1:
100,000, and in UDT 1: 2550.
PROGNOSIS
According to Docimo, the success of the UDT operation was 92% distal to the
internal inguinal annulus, inguinal location (89%), orchidopexy microvascular
techniques (84%), standard abdominal orchidopexy (81%) staged Fowler-Stephens
orchidopexy (77%), Fowler-Stephens standard orchidopexy (67%).
UDT usually drops spontaneously without intervention in the first year of life. The
risk of malignancy is higher than normal testes. Fertility in bilateral UDT: 50% have
children, while UDT is unilateral 80%.