It is the testicle that has an unstable position between the normal position of the testicle inside the scrotum and the inguinal canal or its outer mouth and may be due to increased reflex of the hanger muscle and the maintenance of long length of the abdomen.
At birth it is located in the scrotum and then is found higher, while the corresponding hemisphere is fully formed. This is not a variation of the normal position of the testicle, as previously reported, as of the total ascending testicles 30% descend to the scrotum, 32% ascend to a higher position (acquired cryptorchidism) while 38% remain ascending.
The frequency of testicular ascent (3.9% of testicular descent abnormalities) is proportional to the contraction of the hanger and inversely proportional to testosterone secretion.
So we see it being very small until the age of 3 months increasing until the age of 9 years and then decreasing with increasing testosterone.
20-32% of children with a raised testicle will be led to acquired cryptorchidism.
clinical examination
A raised testicle is usually diagnosed by a pediatrician during a routine examination. The patient should be examined in a supine, sitting position and in a deep seat (frog position), in a calm and warm environment, while the examinee’s hands should have the same temperature as the patient’s body and the palpation movements should be slow. and soft. If the patient is not calm the test should be repeated.
Tangible testicle. If the testicle is not found in the scrotum, an attempt is initially made to palpate it in the corresponding groin, corresponding to the course of the descent. Once located in the groin, an attempt is made to descend to the scrotum with a palpable palpation. If the testicle comes down and remains in the scrotum it is a raised testicle. If the testicle returns immediately outside the scrotum, the examination is repeated or the advice of a pediatric surgeon is sought. It is very important to separate the cryptorchidism from the ascending testicle.
Because cryptorchidism must be operated on in the 6th month of life while the ascending testicle simply needs monitoring, for the possibility of acquired cryptorchidism, until the age of 9-10 years where the largest percentage will be fixed in the scrotum.
The clinical distinction between ascending testis and cryptorchidism is sometimes difficult.
DIAGNOSIS
Only a clinical examination can document the diagnosis of a raised testicle. However, the ultrasound examination contributes to the study of the composition and morphology of the testicle, to the determination of its dimensions and to the coexistence of inguinal hernia or hydrocele. The ultrasound examination should be performed by a radiologist who has experience in examining infants and children and the laboratory should have an ultrasound scanner with appropriate specifications. There are cases where due to the poor approach of the patient and due to the increased contraction of the hanger, the diagnosis of cryptorchidism was given to children who did not have it.
TREATMENT
The ascending testicle does not need surgical rehabilitation but monitoring until the age of 10, when about 90% will be fixed in the scrotum. Monitoring is imperative because 20 – 32% of children with a raised testicle will be led to acquired cryptorchidism and then surgery should be immediate.
An indication for surgical restoration is the development of acquired cryptorchidism and the reduction of the size of the testicle.
The view, in the last two years, that he should have surgery outside the above indications, is not sufficiently substantiated.
Writes:
Pergamalis George
Pediatric Surgeon
Director of the 3rd Pediatric Surgery Clinic, MITERA
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