UDT

• 17 Apr 2020 09:05:15 PM
• |Pediatic Urology

5 year old boy presented with swelling of left scrotom which increases in size with standing  n decrease with sleep.

Comments(7)

• 

  Dr. Anil Takvani

  17 Apr 2020 09:48:45 PM

  No more investigations in this case.

  Right inguinal exploration is the way to go forward in this case.

  Dissect the sac till deep inguinal ring.

  Open the sac and identify testis and cord.

  Do careful dissection of cord at deep inguinal ring from posterior layer of sac.

  Do high ligation of sac at deep inguinal ring.

  Mobilise cord adequately to reroute testis and cord into scrotum without tension.

  Put the testis in sub dartous pouch.

  Another option in a case of unilateral non palpable testis is laparoscopic exploration.

  But in this case as there is hernia/hydrocele I will prefer to go for an open exploration.

  No role of CT/MRI. Do not waste time and resources.

  As testis is not palpable , do not promise parents that you will bring testis in scrotum for sure. Explain all possibilities...

  Thanks

  
  

• 

  Tikenjit Mazumdar

  17 Apr 2020 10:06:17 PM

  Sir as usg is not showing testis in scrotom or inguinal region?what should be d approach...  Inguinal exploration and then lap exploration?or

  confirm location by doing other investigation like mri  and then proceed?

  Parents r not concern about hernia repair,but more concerned about presence or absence of testis.

  
  

• 

  Dr. Anil Takvani

  17 Apr 2020 10:18:21 PM

  I answered your quarry.

  Inguinal exploration. No to MRI/CT or any other investigations in case of unilateral non palpable testis.

  With negative CT/MRI, you can not say testis is not there.

  With positive comment of presence of testis like structure in CT/MRI, you can not promise presence of testis and you will bring it in scrotum for sure.

  Please find out false positive and false negative with CT/MRI and exact utility of these investigations in cases of UDT!!! 

• 

  Tikenjit Mazumdar

  18 Apr 2020 01:10:43 PM

  Thanks u sir....

  Some more queries I have if I may...

  How we should have proceeded if bilateral testis were not palpable in testsi or groin in this case?

• 

  Altaf Khan

  18 Apr 2020 10:34:01 PM

  Dear Anil Takvani Sir,

  In this case, since right testis is not visible in scrotum or inguinal region in ultrasound, I feel laparoscopic exploration before inguinal incision will help if testis is located high in the pelvis and we are not able to bring it down by inguinal approach.

• 

  Dr. Anil Takvani

  19 Apr 2020 08:11:11 AM

  Dear Dr.  Altaf, 

  I agree with you. 

  I have mentioned laparoscopy in my first response.

  In my experience when patient present clinically with unilateral hernia with undescended testis most of the time testis is there as hernia content. 

  Thanks  

• 

  Dr Prashant Mulawkar

  24 Apr 2020 06:35:49 PM

  No need of CT or MRI

  No Need of laparoscopy

  PALPATE UNDER ANESTHESIA

  Clinically the right scrotum is well developed. I am expecting to see the testis in canal

  Explore by inguinal approach, you would mostly get the testis in the canal

  If you do not see the testis in the canal proceed as below

  A: Try to dissect proximally , mostly you would get the testis in retroperitoneum. 

  If you do not get the testis

  B: Consider laparoscopy

  
  

  If the scrotum is not well developed (which is not the case here) and the testis is not palpable under anesthesia, consider laparoscopy