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A 4 month old baby boy is brought to the physician for a follow up visit. in the previous visit, the PE revealed an empty scrotom. The abd usg shows undescended testes. There are no new changes in the PE. What is the most appropriate next step in the care of this patient?
a. refer the patient for elective surgery
b. refer the patient for surgery immediately
c. wait until 1 year of age before making a decision
d. waiti until 6 months of age before making a decision
e. order an abdominal CT scan
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d. waiti until 6 months of age before making a decision
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yes don't do anything before 6 months but if at 6 months they are not there...then do surgery!
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You guys finished UW already?
According to Kaplan step 2 ped notes, do surgey if testes do not descend by 1 year. so it is CC?
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nope if it's descending on/off then yes it's up to 1 year
but pure cyptorchidism (never descended) is 6 months....these kids are at risk of testicular tumors if you don't treat them...(similar to feminizing testicle)
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just to add, the risk for ca is still there even if you brought the ball down but what you want to prevent is infertility. abnormaliteies in spermatogonia begins at 6 mos of age. environment is better down there than in the heated kitchen
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just read...
The following age-related observations have been made based upon testicular biopsies performed at the
time of orchiopexy in boys with cryptorchidism:
Germ cell density decreases over time, beginning as early as one year of age [26,41-43].
The normal transformation of the fetal gonocyte into the adult dark-type spermatogonia that occurs by
six months of age in the normally descended testicle is impaired in the undescended testicle; the fetal
gonocytes persist and then undergo degeneration [43].
In children two years of age, 30 to 40 percent of undescended testicles had no spermatogonia
[30,44-46].
In boys with unilateral cryptorchidism, primary spermatocytes failed to appear in the undescended
testicle and were present in only 19 percent of the contralateral testicles in those 4 to 5 years of age [ 42].
Most post-pubertal unilateral abdominal testes have absent spermatogenesis [47].
These observations suggest that changes related to fertility occur in the undescended testicle in a child as
young as one year of age, and to the extent that orchiopexy alters this process, it is best performed before
the changes occur, ideally as soon as possible after six months of age [48]
48. Martin Ritzen, E, Bergh, A, Bjerknes, R, et al. Nordic consensus on treatment of undescended testes.
Acta Paediatr 2007; 96:638
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Thanks guys. as far as i recall doing UW step 2, it is also 1 year of age to do surgery in undescended testes. I am not sure though. So kaplan ck notes are not right?
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for undescended they may be....oski's peds also says 6mo for undescended
