Cryptorchidism physical examination: Difference between revisions

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{{CMG}} {{AE}} {{SME}}
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==Overview==
==Overview==
The most common diagnostic dilemma in otherwise normal boys is distinguishing a [[retractile testis]] from a [testis]] that will not/cannot descend spontaneously into the [[scrotum]]. [[Retractile]] testes are more common than truly undescended testes and do not need to be operated on. In normal males, as the [[cremaster muscle]] relaxes or contracts, the testis moves lower or higher ("retracts") in the scrotum. This [[cremasteric reflex]] is much more active in infant boys than older men. A retractile testis high in the scrotum can be difficult to distinguish from a position in the lower inguinal canal. Though there are various maneuvers used to do so, such as using a crosslegged position, soaping the examiner's fingers, or examining in a warm bath, the benefit of surgery in these cases can be a matter of clinical judgement.
The most common diagnostic dilemma in otherwise normal boys is distinguishing a retractile testis from a [[testis]] that will not/cannot descend spontaneously into the [[scrotum]]. Retractile testes are more common than truly undescended testes and do not need to be operated on. In normal males, as the [[cremaster muscle]] relaxes or contracts, the testis moves lower or higher ("retracts") in the scrotum. This [[cremasteric reflex]] is much more active in infant boys than older men. A retractile testis high in the scrotum can be difficult to distinguish from a position in the lower inguinal canal. Though there are various maneuvers used to do so, such as using a crosslegged position, soaping the examiner's fingers, or examining in a warm bath, the benefit of surgery in these cases can be a matter of clinical judgement.
 
In the minority of cases with bilaterally [[non-palpable]] testes, further testing to locate the testes, assess their function, and exclude additional problems is often useful. Pelvic [[ultrasound]] or [[magnetic resonance imaging]] can often, but not invariably, locate the testes while confirming absence of a uterus. A [[karyotype]] can confirm or exclude forms of [[dysgenetic]] primary [[hypogonadism]], such as [[Klinefelter syndrome]] or [[mixed gonadal dysgenesis]].
[[Hormone]] levels (especially [[gonadotropins]] and AMH) can help confirm that there are hormonally functional testes worth attempting to rescue, as can stimulation with a few injections of [[human chorionic gonadotropin]] to elicit a rise of the [[testosterone]] level. Occasionally these tests reveal an unsuspected and more complicated [[intersex]]condition.
 
In the even smaller minority of cryptorchid [[infants]] who have other obvious birth defects of the [[genitalia]], further testing is crucial and has a high likelihood of detecting an[[intersex]] condition or other anatomic anomalies. Ambiguity can indicate either impaired androgen synthesis or [[androgen insensitivity syndrome|reduced sensitivity]]. The presence of a [[uterus]] by pelvic [[ultrasound]] suggests either [[persistent müllerian duct syndrome]] (AMH deficiency or insensitivity) or a severely virilized genetic female with [[congenital adrenal hyperplasia]]. An unambiguous [[micropenis]], especially accompanied by [[hypoglycemia]] or [[jaundice]], suggests congenital[[hypopituitarism]].


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Latest revision as of 21:11, 29 July 2020

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Overview

The most common diagnostic dilemma in otherwise normal boys is distinguishing a retractile testis from a testis that will not/cannot descend spontaneously into the scrotum. Retractile testes are more common than truly undescended testes and do not need to be operated on. In normal males, as the cremaster muscle relaxes or contracts, the testis moves lower or higher ("retracts") in the scrotum. This cremasteric reflex is much more active in infant boys than older men. A retractile testis high in the scrotum can be difficult to distinguish from a position in the lower inguinal canal. Though there are various maneuvers used to do so, such as using a crosslegged position, soaping the examiner's fingers, or examining in a warm bath, the benefit of surgery in these cases can be a matter of clinical judgement.

References

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