Diagnóstico e tratamento do criptorquismo

Abstract

Cryptorchidism corresponds to the extra-scrotal position of the testis, and can be found in 3% of the term newborns and 0.5 to 1.0% of adults. It is usually an isolated clinical feature, but in around 10% of the cases can be associated to hypothalamic-pituitary dysfunction and genetic or embryonic disorders. The presence of additional genital abnormalities, such as hypospadia or micropenis, increases the probability of the diagnosis of an intersex condition. Detailed description of the testicular anatomic position is essential to adequate diagnosis, treatment and prognostic evaluation. The diagnosis of cryptorchidism is made by clinical examination. The complementary exams, such as image analysis, add limited information on the diagnosis. Gonadotropins and testicular hormones measurement can be useful if the hypothalamic-pituitary-gonadal axis is activated, as observed during the first 6 months of life or during puberty. Clinical treatment is indicated in patients with retained testis or in severely retractile testis. In these cases, human chorionic gonadotropin is employed at a dose of 50 IU/kg/week for 6 consecutive weeks. Clinical treatment cannot be used in cases of confirmed inguinal hernia, varicocele or spermatic cord cysts. Surgical correction is indicated after failure of clinical treatment or for ectopic testes. The long-term prognosis of cryptorchidism seems to be related to the precocity of the therapy. Therefore, recognition and treatment of cryptorchid testes should be done during the first 2 years of life, potentially improving the risks of infertility and gonadal neoplasia.

Genital morphology of the male South American fur seal (Arctocephalus australis) and biological implications

“…There is a direct association of vaginal tunic with the cremaster muscle in A. australis as described also for bulls, dogs, equines, and other animals (Nickel et al 1979). The strong cremaster muscular fibers attach to the vaginal tunic to approach or separate the testis to/from the scrotum, a maneuver that reduces the processus vaginalis peritonei size influencing the motion of the testis, which, associated with the blood circulation of the cremaster muscle, helps regulate the temperature of the testes (Anderson et al 1988, Longui 2005. Microscopically, the tunica albuginea is constituted by collagen fibers, less numerous elastic fibers, smooth muscle, and a high number of blood vessels.…”

Formación embriológica del canal inguinal

“…Puede ser unilateral o bilateral [11]. En el 80% de los casos, el testículo no descendido es palpable en el canal inguinal [12].…”

Testicular histology after intestinal pedicle flap (cecum) apposition in rats

“…The incidence is 33% in premature infants, 4% to 5% in live mature births and 0.8% to 1% at the end of the first year of life. Currently, orchidopexy is proposed between 6 months and 12 months of age to bring the gonad down into the scrotum 4,5 . Several efforts have been made to preserve gonad blood flow when performing this kind of procedure, mainly in the cases when it is necessary to ligate the testicular pedicle.…”