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  #1  
Old 06-01-2011
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Kids difficulty locating the right testis...the MOST likely diagnosis is...

A 2-year-old boy who has been followed by your practice since birth presents for a health supervision visit. On careful physical examination, you have difficulty locating the right testis. In reviewing your records, you note that this is a new finding.

Of the following, the MOST likely diagnosis is:

a) agenesis of the testis
b) indirect inguinal hernia
c) pseudohermaphroditism
d) retractile testis
e) undescended testis
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Old 06-01-2011
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My first thought was that it is and undescended testis that had not been detected on previous exams. I remembered a pediatrician telling me of a 10 year with an undescended testis that was not noticed until he was ten....

However a google search brought the following answer:


ANSWER: D

Because the boy described in the vignette has had normal findings on previous testicular examinations, it is likely that the cremasteric reflex is causing retractile testis, preventing examination of the testis on this visit. A warm examination room, warm compresses to the inguinal area, or having the boy sit in the "tailor's position" (sitting with knees flexed and ankles crossed on the examination table) or squatting may facilitate descent of the normal testis back into the scrotal sac. Retractile testis is not common in early infancy or after puberty. Agenesis of the testis is unlikely because the testes were palpable on previous examinations. Indirect inguinal hernia would be associated with an inguinal mass, but the testis would still be palpable on examination.

True undescended testis is the single most common genitourinary problem in boys. Bilateral undescended testes may be associated with chromosomal or endocrine disorders, including pseudohermaphroditism as well as other syndromes and should be evaluated with careful attention to the presence of other malformations or metabolic disturbances. A normal-appearing penis implies intact testicular tissue, but chromosomal and endocrine studies should be performed. An endocrine consultation may be appropriate in an infant who has bilateral undescended testes, but it is not necessary for a child who has a unilateral undescended testis.

Failure of the testis to descend along the appropriate track from the abdomen through the inguinal ring and into the scrotal sac may be associated with infertility and up to a 40% increase in the risk for testicular cancer, which would be undetected in the abdominal location. Structural changes in the undescended testis have been documented as early as 2 years of age and diminished sperm production as young as 6 years.

Although administration of beta human chorionic gonadotropin has been used infrequently to effect testicular descent, it is not believed to be very effective. Adverse effects include premature closure of the epiphyses and premature onset of secondary sex characteristics (reversible). Laparoscopic orchiopexy of the presumably present unilateral undescended testis is the current treatment of choice and usually is performed at 1 year of age.
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Old 06-01-2011
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Thanks

I would have gone for undescented testis too.
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Quote:
Originally Posted by bebix View Post
In reviewing your records, you note that this is a new finding.
d) retractile testis
e) undescended testis
I think here it is D, but during my work I met lot of not diagnosed undescended testis (option E).
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