İnmemiş testis ve eşzamanlı kasık fıtığı birlikteliği: Derleme [Undescended testis and the presence of concurrent inguinal hernia: A review]

Year 2012, Volume: 39 Issue: 3, 462 - 466, 01.09.2012

Yaşar Bozkurt Ahmet Ali Sancaktutar Yusuf Kibar

https://doi.org/10.5798/diclemedj.0921.2012.03.0183

Abstract

Cryptorchidism is defined as testes nonpalpabl in the scrotum. And they are generally undescended or aplastic. Cryptorchidism usually occurs among infants with congenital disorders and most cryptorchidic testicles are undescended. Between 2% and 5% of full-term and 30% of premature male infants are born with an undescended testicle. Approximately 10% of undescended testicle is bilateral and the most common location is just outside the external inguinal ring. Inguinal hernia that is characterized as patent prosesus vaginalis (PV) is the most common seen pathology concomitant to undescended testes. Primary inguinal hernia is present 1-5% of all infants. But this ratio rises up to 9-11% of premature babies. The patients are usually asymptomatic and the treatment needs surgical procedures. If urgent surgery is needed for incarcerated or strangulated inguinal hernia, orchiopexy procedure should be made together. In other conditions inguinal hernia requirement must be done during routine orchiopexy. The inguinal hernia with untreated undescended testes which is occult may become symptomatic or complicated such as incarceration or strangulation at any time. The incidence of inguinal hernia in the patients with undescended testes is controversial that different rates are reported in different series. According to our review of the literature, we determined that the rate of inguinal hernia and patent PV accompanying to undescended testes is 20% and 50%, respectively.

Keywords

Cryptorchidism, Inguinal hernia.

İnmemiş testis ve eşzamanlı kasık fıtığı birlikteliği: Derleme

Abstract

Skrotumda yer almayan testis için kriptorşidizm terimi kullanılır. Kriptorşid testisler ya yoktur veya inmemiştir. Kriptorşidizm, konjenital hastalıkları olan bebeklerde daha sık görülür ve en sık inmemiş testis şeklinde karşımıza çıkar. Miadında doğan erkek bebeklerin %2 ile %5\'inde ve erken doğan bebeklerin ise %30\'unda inmemiş testis bulunmaktadır. İnmemiş testislerin yaklaşık olarak %10\'u çift taraflı olup en sık bulunduğu bölge eksternal inguinal halkanın hemen ağzıdır. İnmemiş testise en sık eşlik eden bozukluk inguinal herni olup, oluşumunda temel etken prosesus vajinalisin (PV) açık kalmasıdır. Primer inguinal herni, tüm yenidoğanların yaklaşık olarak %1 ile %5\'inde görülür ve bu oran prematür doğan bebeklerde %9 ile %11\'e kadar yükselir. Fıtığı olan bebeklerde genellikle semptom yoktur ve tedavi gerekiyorsa cerrahi işlem uygulanmalıdır. İnkarsere veya strangüle olan kasık fıtığı için acil ameliyat gerektiğinde, eş zamanlı inmemiş testis de eşlik ediyorsa orşiyopeksi yapılmalıdır. Ayrıca rutin orşiyopeksi yapılıyor ve inguinal herni de mevcutsa eş zamanlı herni tamiri de yapılmalıdır. Tedavi edilmeyen inmemiş testise eşlik eden bilinmeyen inguinal herniler, ilerleyen zamanda sıkışarak veya boğularak semptomatik hale gelebilirler. Kriptorşidik hastalarda görülen herni oranı tartışmalı bir konu olup değişik serilerde değişik yüzdeler bildirilmiştir. Yaptığımız literatür taramasında inmemiş testisli hastalara eşlik eden PV açıklığı ve inguinal herni oranlarının sırasıyla % 50 ve % 20 dolayında olduğunu gördük.

Keywords

Kriptorşidizm, inguinal fıtık.

References

• Pillai SB, Besner GE. Pediatric testicular problems. Pediatr Clin North Am 1998; 45(4): 813-30.
• Frey HL, Rajfer J. Role of the gubernaculum and intraab- dominal pressure in the process of testicular descent. J Urol 1984;131(3): 574-9.
• Kirsch AJ, Escala J, Duckett JW, et al. Surgical management of the nonpalpable testis: the Children’s Hospital of Phila- delphia experience. J Urol 1998;159(4): 1340-3.
• Barthold JS, Gonzalez R. The epidemiology of congenital cryptorchidism, testicular ascent and orchiopexy. J Urol 2003; 170(6): 2396-401.
• Sijstermans K, Hack WW, Meijer RW, van der Voort-Doede- ns LM. The frequency of undescended testis from birth to adulthood: a review. Int J Androl 2008; 31(1): 1-11.
• Brandt ML. Pediatric hernias. Surg Clin North Am 2008; 88(1): 27-43.
• Leung AK, Robson WL. Current status of cryptorchidism. Adv Pediatr 2004; 51: 351-77.
• Wolf CK, Maizels M, Furness PD, 3rd. The undescended tes- ticle. Compr Ther 2001; 27(1): 11-7.
• Rozanski TA, Bloom DA. The undescended testis. Theory and management. Urol Clin North Am 1995; 22(1): 107-18.
• Taşkesen F, Arıkanoğlu Z, Okudan M, Egeli T, Çiftçi T. Amyand’s hernia: Case report. J Clin Exp Invest 2011; 2(4): 446-8.
• Balkan M, Otçu S, İsi H, et al. Ambigious Genitalyalı Bir Erkekte 46,XX, Karyotipi: Olgu Sunumu. Dicle Tıp Dergisi 2004;31(2): 65-7.
• Hutson JM, Beasley SW. Embryological controversies in testicular descent. Semin Urol 1988; 6(2):68-73.
• Husmann DA, Levy JB. Current concepts in the pathophysi- ology of testicular undescent. Urology 1995;46(2): 267-76.
• Attah AA, Hutson JM. The role of intra-abdominal pressure in cryptorchidism. J Urol 1993;150(3): 994-6.
• Rajfer J, Walsh PC. Hormonal regulation of testicular descent: experimental and clinical observations. J Urol 1977;118(6): 985-90.
• Tanyel FC, Ulusu NN, Tezcan EF, Buyukpamukcu N. Total calcium content of sacs associated with inguinal hernia, hy- drocele or undescended testis reflects differences dictated by programmed cell death. Urol Int 2003;70(3): 211-5.
• Grosfeld JL. Current concepts in inguinal hernia in infants and children. World J Surg 1989;13(5):506-15.
• Kapur P, Caty MG, Glick PL. Pediatric hernias and hydro- celes. Pediatr Clin North Am 1998;45(4): 773-89.
• Peevy KJ, Speed FA, Hoff CJ. Epidemiology of inguinal hernia in preterm neonates. Pediatrics 1986;77(2): 246-7.
• Harper RG, Garcia A, Sia C. Inguinal hernia: a common problem of premature infants weighing 1,000 grams or less at birth. Pediatrics 1975;56(1): 112-5.
• Skoog SJ, Conlin MJ. Pediatric hernias and hydroceles. The urologist’s perspective. Urol Clin North Am 1995;22(1): 119-30.
• Sarpel U, Palmer SK, Dolgin SE. The incidence of com- plete androgen insensitivity in girls with inguinal hernias and assessment of screening by vaginal length measure- ment. J Pediatr Surg 2005;40(1): 133-6.
• De Muinck Keizer-Schrama SM, Hazebroek FW. Hormonal treatment of cryptorchidism: role of pituitary gonadal axis. Semin Urol 1988;6(2): 84-95.
• Hagberg S, Westphal O. Treatment of undescended testes with intranasal application of synthetic LH-RH. Eur J Pedi- atr 1982;139(4): 285-8.
• Pyorala S, Huttunen NP, Uhari M. A review and meta-anal- ysis of hormonal treatment of cryptorchidism. J Clin Endo- crinol Metab 1995;80(9): 2795-9.
• Ritzen EM, Bergh A, Bjerknes R, et al. Nordic consensus on treatment of undescended testes. Acta Paediatr 2007;96(5): 638-43.
• Gill B, Kogan S. Cryptorchidism. Current concepts. Pediatr Clin North Am 1997;44(5): 1211-27.
• Dayanç M, Kibar Y, Irkılata HC, Korğalı E, Örs AÖ. . [Scrotal Orchıopexy Results Of Inguınal Hernıa Repaır Assocıated Wıth Cryptorchıdısm]. Türk Üroloji Dergisi 2007; 33(2): 181-4.
• Heikkila J, Taskinen S, Toppari J, Rintala R. Posterior ure- thral valves are often associated with cryptorchidism and inguinal hernias. J Urol 2008;180(2): 715-7.
• Ismail K, Ashour M, El-Afifi M, et al. Laparoscopy in the management of impalpable testis: series of 64 cases. World J Surg 2009;33(7): 1514-9.
• Lim KT, Casey RG, Lennon F, Gillen P, Stokes M. Crypt- orchidism: a general surgical perspective. Ir J Med Sci 2003;172(3): 139-40.
• Parsons JK, Ferrer F, Docimo SG. The low scrotal approach to the ectopic or ascended testicle: prevalence of a patent processus vaginalis. J Urol 2003;169(5): 1832-3.
• Bassel YS, Scherz HC, Kirsch AJ. Scrotal incision orchio- pexy for undescended testes with or without a patent pro- cessus vaginalis. J Urol 2007;177(4): 1516-8.
• Backhouse KM. The natural history of testicular descent and maldescent. Proc R Soc Med 1966;59(4): 357-60.
• Shrock P. The processus vaginalis and gubernaculum. Their rai- son d’etre redefined. Surg Clin North Am 1971;51(6): 1263-8.
• Rusnack SL, Wu HY, Huff DS, et al. The ascending testis and the testis undescended since birth share the same histo- pathology. J Urol 2002;168(6): 2590-1.
• Capello SA, Giorgi LJ, Kogan BA. Orchiopexy practice patterns in New York State from 1984 to 2002. J Urol 2006;176(3): 1180-3.
• Varela-Cives R, Bautista-Casasnovas A, Taboada-Santomil P, et al. Relevance of herniography for accurate diagnosis of patent processus vaginalis in cryptorchidism. Int Braz J Urol 2008;34(1): 57-62.
• Giannopoulos MF, Vlachakis IG, Charissis GC. 13 Years’ experience with the combined hormonal therapy of crypt- orchidism. Horm Res 2001;55(1): 33-7.
• Elder JS. Cryptorchidism: isolated and associated with other genitourinary defects. Pediatr Clin North Am 1987;34(4): 1033-53.
• Atwell JD. Ascent of the testis: fact or fiction. Br J Urol 1985;57(4): 474-7.
• Eardley I, Saw KC, Whitaker RH. Surgical outcome of orchidopexy. II. Trapped and ascending testes. Br J Urol 1994;73(2): 204-6.
• Mayr J, Rune GM, Holas A, Schimpl G, Schmidt B, Haberlik A. Ascent of the testis in children. Eur J Pediatr 1995;154(11): 893-5.
• Gracia J, Navarro E, Guirado F, Pueyo C, Ferrandez A. Sponta- neous ascent of the testis. Br J Urol 1997;79(1): 113-5.
• Clarnette TD, Rowe D, Hasthorpe S, Hutson JM. Incom- plete disappearance of the processus vaginalis as a cause of ascending testis. J Urol 1997;157(5): 1889-91.
• Riquelme M, Aranda A, Rodriguez C, Cortinas J, Carmona G, Riquelme QM. Incidence and management of the inguinal hernia during laparoscopic orchiopexy in palpable cryptoorchi- dism: preliminary report. Pediatr Surg Int 2007;23(4): 301-4.