Testis incomplete descent

Incomplete Descent

*     The testis is arrested at some point in its normal course of descent (Fig. 27.3) and is palpable on examination.

*     Usual sites is internal inguinal ring, there may be an associated congenital indirect inguinal hernia; if processes vaginalis has not been obliterated

*     Exploration with a high inguinal incision exposing the entire cord upto the internal inguinal ring is required.

*     The cord is completely freed from the processes vaginalis which is excised, neck of the peritoneal sac is closed.

·                The testis is then positioned and fixed within the scrotum (orchidopexy) using a variety of techniqes

Transeptal orchidopaxy Steps

-        testis identified in inguinal canal

-        open ingiunal canal

-        identify hernia sac and ligate

-        mobilize and leagnthen cord till it reaches scrotum

-        make an opening in the septal wall of scrotum

-        transpose testis through this opening

Close the inguinal canal and wound

*     Use of chronic gonadotropic in dosages of upto 500 units three times weekly for six weeks as stimulus to testicular descent may also be tried

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Testis Urethra 2 development testis

TESTIS

3.1 Development

      The testis is developed from the genital fold of mesoderm lying below the developing kidney in the retroperitoneal space. The developing testis migrates from this intrabdominal position to the scrotum and takes with it a fold of peritoneum the tunica vaginalis.

3.2 Cryptorchidism

      The term “Cryptorchidism” should be reserved for those testis that are usually within the abdominal cavity and not palpable on examination.

*     Cryptorchid or intra-abdominal testis are observed unilaterally or bilaterally in 1 to 10% of male infants, cause is not known.

*     The Cryptorchid abdominal testis, if left untreated, will fail in its spermatogenic function.

*     It may however, secrete adequate amounts of androgens. Surgical intervention to bring it to the scrotum should be accomplished before the age of two years.

*     In unilateral cryptorchidism, surgical exploration is less urgent

*     In bilateral crypotrchidism, early surgical intervention is necessary.

*     For high intrabdominal testis anastmosis to inferior epigastric and testicular vessals is being practiced using micro-surgical techniques (Silber and Kelly)

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Testis Urethra 1

ANATOMY

      The scrotum is a fibromuscular sac covered with skin it is red brown in colour and the skin has rugae (fold) the skin has sweat glands and sebaceous glands. The dartos muscle is deep to skin. The sac contains the testis epididymas tunica, Vaginalis and the cord structures (Fig 27.1).

1.1 The testis are paired and one testis is placed in one half of the serotum on the back of the testis is the epididymis a coiled tube that ends in a straight tube the vas deference this vas deferens opens into the posterior urethra

1.2 The testis in cross section show that it is packed with coiled seminiferous tubes, all these tubes produce sperms and the tubes end into the epididymis.

1.3 A cross section of the penis show that it is made spongy muscular tissue the two corpura cavernosa and the centrally placed corpura spongiosum with the urethra running through its middle. These three have many vascular space which when engorged with blood give regidity to the organ.

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Bladder Trauma

BLADDER TRAUMA

      The urinary bladder can be injured in case of blunt injury to abdomen and can occur with or without fracture of the pelvis. This rupture of the bladder can lead to extravasation of urine into the peritoneal cavity or into the extraperiteal space (Fig26.8). This is because the bladder partly intraperitaneal and the rest extra pertoneal. Intropertoneal extravasation produces severe pain in the hypogastrium with shock (syncope). The abdomen starts to distened. Examination will show gaurding and with large extravastion shifting dullness there will be no desire to pass urine extraperitaveal rapture will have little or no abdominal complaints but there will be retention of urine.

13.1 TREATMENT

Required early diagnosis in blunt injury cases confirmation by cystography if required and a surgical repair in two layers of the rupture in the bladder wall is essential.

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