2.3 Treatment
The objective of treatment is to achieve an orthotopic scrotal position of the testis, before the child's second birthday, in order to prevent irreversible damage of spermatogenesis in the affected testis. Hormone therapy (optional) is applied for testis retention only. It is ineffective for ectopy, but can be helpful for preparation of local tissue: HCG as an intramuscular injection (9000-30,000 III in different protocols) or luteinizing hormone releasing hormone (LHRH) as a nasal spray (400 ug, three times daily). Both methods are effective in about 20-30% of cases. Follow-up is important because the benefits may fail after a period of time.
Surgical orchidofuniculolysis and orchidopexy are first-line treatment options. Pendulous (retractile) testes are not indicated for surgical repair. Absolute indications for a primary surgical approach are testis retention after failed hormone therapy or after previous inguinal surgery, testis ectopy and all maldescended testes with associated pathology (hernia and/or open processus vaginalis). Inguinal access of the spermatic cord is gained after opening the inguinal canal. Associated pathological conditions (open processus vaginalis, inguinal hernia) are dealt with in the same session. After the spermatic chord and testis have been freed of connective tissue and cremaster fibres have been resected, the testis is relocated tension free by pexis in the scrotum. If no testis or spermatic funicle tissue can be found during exploration of the inguinal canal, opening of the peritoneum and intraperitoneal orchidofuniculolysis is performed. If the spermatic funicle is too short, the Fowler-Stephens technique (ligation and dissection of the spermatic vessels) can be applied. Pre-conditions are intact deferent duct and epididymis vessels; these are tested by a temporary clamping of the testicular artery. In rare cases, auto-transplantation by microsurgical anastomosis of the testis vessels with the epigastric vasculature can be considered.
Table 1: Management of cryptorchidism
CRYPTORCHIDISM
Physical examination sonography
Detectable
Unilateral undetectable
Bilateral undetectable
MRI (optional)
HCG stimulation
- 1. Phimosis
- 1.1 Background
- 1.2 Diagnosis
- 1.3 Treatment
- 1.4 References
- 2.2 Diagnosis
- 2.3 Treatment
- V Therapy
- 3.3 Treatment
- 3.3.1 Complications
- Tube-onlay
- 15. Duckett jw.
- 4.2 Classification
- 4.2.1 Enuresis
- 4.2.2 Urinary incontinence
- 4.3 Diagnosis
- 4.4 Treatment
- 4.4.1 Nocturnal enuresis (mono-symptomatic)
- 4.4.2 Diurnal enuresis (in children with attention disorders)
- 4.4.3 Urinary incontinence
- 4.4 References
- 14. Madersbacher h, Schultz-Lampel d.
- 5.2.2 Voiding cystourethrography (vcug)
- 5.2.3 Diuresis renography
- 5.2.4 Static renal scintigraphy
- 5.2.5 Intravenous urogram (ivu)
- 5.2.6 Whitaker's test
- 5.3 Treatment
- 5.3.2 Megaureter
- 5.3.3 Ureterocele
- 5.3.4 Retrocaval ureter
- 5.3.5 Bilateral hydronephrosis
- 5.4 References
- 6.3 Treatment
- 6.3.1 Asymptomatic bacteriuria
- 6.3.2 Acute uti without pyelonephritis
- 6.3.3 Pyelonephritis
- 6.3.4 Complicated uti
- 6.3.5 Antibiotic prophylaxis
- 6.4 References
- 7.7.1 Secondary reflux
- 7.2 Classification
- 7.3 Diagnosis
- 7.3.1 Secondary reflux
- 7.4 Treatment
- 7.4.1 Conservative therapy
- 7.4.2 Surgical therapy
- 7.4.3 Endoscopic therapy
- 7.4.4 Open surgery
- 7.4.5 Follow-up
- 7.5 References
- 32. McGladdery sl, Aparicio s, Verrier Jones k, Roberts r, Sacks sh.
- 8.2 Diagnosis
- 8.3 Treatment
- 8.3.1 Conservative treatment
- 8.3.2 Metaphylaxis of paediatric nephrolithiasis
- 8.4 References
- 1. Brandle e, Hautmann r.
- 2. Brandle e, Hautmann r.
- 6. Diamond da, Rickwood am, Lee ph, Johnston jh.
- 19. Kovacevic l, Kovacevic s, Smoljanic z, Peco-Antic a, Kostic n, Gajic m, Kovacevic n, Jovanovic o.
- 20. Kroovand rl.
- 24. Minevich e, Rousseau mb, Wacksman j, Lewis ag, Sheldon ca.
- 9.2 Classification
- 9.2.1 Ectopic ureterocele
- 9.2.2 Orthotopic ureterocele
- 9.2.3 Caecoureterocele
- 9.3 Diagnosis
- 9.3.1 Ureterocele
- 9.3.2 Ectopic ureter
- 9.4 Treatment
- 9.4.1 Ureterocele
- 9.4.2 Ectopic ureter
- 10.2 Classification
- VI. Miscellaneous (? Dysgenetic testes ? teratogenic factors)
- 10.3.2 Late diagnosis and management
- 10.4 Treatment
- 10.4.1 Genitoplasty
- 10.4.2 Indications for the removal of gonads
- 10.5 References
- 11.1.4 Video-urodynamic evaluation
- 11.1.5 Urethral pressure profile (sphincterometry)
- 11.1.6 Electromyography (emg) of the external sphincter
- 11.2 References
- 22. Starr nt.
- 23. Wan j, Greenfield s.
- 26. Zermann dh, Lindner h, Huschke t, Schubert j.
- 12 Abbreviations used in the text