Sie sind auf Seite 1von 5

Pathophysiology of Cryptorchidism

Presented to the Faculty

Of the College of Nursing

Cebu Normal University

In Partial Fulfilment of the Requirements

Of the Degree Bachelor of Science in Nursing

Sachi Ciani A. Bautista

2010
A. Definition of Terms

Cryptorchidism
the absence of one or both testes from the scrotum. This usually represents
failure of the testis to move, or "descend," during fetal development from
an abdominal position, through the inguinal canal, into the ipsilateral scrotum.
Derived from the Greek words "crypto" (meaning "hidden") and "orchid" (meaning
"testicle"). During the last century, cryptorchidism was sometimes restricted to the
subset of undescended testes that were not palpable above the scrotum or in the
inguinal canal — those that were truly hidden in the abdomen or completely absent. In
recent decades the distinction is no longer made in most contexts, and the two terms
are used interchangeably. Cryptorchism is an older variant of the same term.
Orchiopexy (or orchidopexy)
a surgery to move an undescended testicle into the scrotum and permanently fix
it there. It is performed by a pediatric urologist or surgeon on boys with cryptorchidism,
typically before they reach the age of two. Some patients remain undiagnosed until their
teenage years and undergo the surgery at that time.

B. Schematic Diagram

Risk Factors:
Severely Premature Infants
Low birth weight
Alcohol consumption during pregnancy
Caffeine intake during pregnancy
Exposure to environmental chemicals
Gestational Diabetes
Hereditary
Androgen or AMH deficiency or insensitivity
Congenital malformation syndromes

Germ cell

C. Explanation
Normal descent occurs during the 7th month of gestation. The majority of testes that
will descend spontaneously do so by 3 months of age, possibly due to the gonadotropin
surge that is responsible for maturation of the germ cells. The undescended testis fails
to show normal maturation at both 3 months and 5 years of age. At 3 months of age, the
fetal gonocytes are transformed into adult dark spermatogonia. At 5 years of age, the
adult dark spermatogonia become primary spermatocytes. Both of these steps are
abnormal in the undescended testis, and to a lesser extent, the contralateral descended
testis. Previous beliefs that the undescended testis was normal between birth and 1
year of age are incorrect, since they were derived from counts of all germ cells without
taking into account whether maturation was occurring. After 2 years of age, thermal
effects on the testis being left out of position are seen independent of the endocrinologic
effects.

D. Scientific Explanation
1. Severely premature infants
A birth is generally considered premature if it occurs more than three weeks before
the due date but after the period of viability (20 weeks or 500g). A premature birth
reduces the amount of time a baby has to grow and develop and if the birth is too
premature, the baby may be insufficiently developed to survive. The testes remain high
in the abdomen until the 7th month of gestation, when they move from the abdomen
through the inguinal canals into the two sides of the scrotum. Premature Infants will
have undescended testes due to viability of his age.

2. Low birth weight


This is mostly due to premature birth or intrauterine growth retardation.

3. Exposure to regular alcohol consumption during pregnancy


5 or more drinks per week, associated with a 3x increase in cryptorchidism, when
compared to non-drinking mothers.

4. Exposure to environmental chemicals (e.g. pesticides)


Exogenous substances that act like hormones in the endocrine system and disrupt
the physiologic function of endogenous hormones

5. Gestational diabetes
Mildly abnormal glucose metabolism during pregnancy  was associated with an
increased risk for congenital cryptorchidism.

6. Caffeine intake during pregnancy


At least 3 drinks per day. In a study, mothers with a high alcohol consumption also
were more frequently smokers and had a higher caffeine intake.

7. Familial/hereditary
Inheritance of Cryptorchidism refers to whether the condition is inherited from your
parents or "runs" in families. The level of inheritance of a condition depends on how
important genetics are to the disease.

8. Androgen or AMH deficiency or insensitivity


In a normal fetus with a 46,XY karyotype, the presence of the SRY gene induces
testes to form on the genital ridges in the fetal abdomen a few weeks after conception.
By 6 weeks of gestation, genital anatomies of XY and XX fetuses are still
indistinguishable, consisting of a tiny underdeveloped button of tissue able to become
a phallus, and a urogenital midline opening flanked by folds of skin able to become
either labia or a scrotum. By the 7th week, fetal testes begin to produce testosterone
and release it into the blood.Directly and as DHT, testosterone acts on the skin and
tissues of the genital area and by 12 weeks of gestation, has produced a recognizable
male, with a growing penis with a urethral opening at the tip, and a perineum fused and
thinned into a scrotum, ready for the testes. Evidence suggests that this "remodelling" of
the genitalia can only occur during this period of fetal life; if not complete by about 13
weeks, no amount of testosterone later will move the urethral opening or close the
opening of the vagina.
For the remainder of gestation, the principal known effect of testosterone and DHT is
continued growth of the penis and internal wolffian derivatives (part
of prostate, epididymis, seminal vesicles, and vas deferens).

9. Congenital malformation syndromes


It may be the result of genetic abnormalities, the intrauterine (uterus) environment,
errors of morphogenesis, infection, or a chromosomal abnormality.

10. Infertility
The male reproductive system creates sperm that is manufactured in the
seminiferous tubules within each testicle. With the failure of the testes to descend, there
is also failure of the system to produce sperm, which then leads to the inability to
conceive.
11. Testicular Cancer
In a study, infertile men may be at risk to developing testicular cancer. The researchers
calculated that men in couples seeking fertility treatment were 1.3 times more likely to
develop testicular cancer than those of the same age in the general population. Men
with male infertility factor were 2.8 times more likely to develop testicular cancer than
other men. The study appears in the Feb. 23 issue of the Archives of Internal Medicine.

E. Nursing Diagnoses
1. Pain related to pressure/swelling
2. Low self-esteem
3. Disturbed body image
4. Disturbed self esteem
5. Knowledge Deficient
6. Risk for disturbed thought process
7. Risk for spiritual distress
8. Risk for sexual dysfunction
9. Risk for ineffective role performance
10. Risk for interrupted family process

F. Diagnostics
1. Physical Examination
If the testicle is in the groin, your doctor may be able locate it by touch. If it can't be felt
(nonpalpable), then he or she will likely refer you to a pediatric urologist for further tests.
About 20 percent of undescended testicles are nonpalpable.
2. Ultrasound
An ultrasound is a noninvasive device that uses sound waves to create images of
internal structures of the body. An ultrasound may enable the pediatric urologist to
locate a nonpalpable testicle, particularly if it's located within the groin.
3. MRI
MRI is a technology that uses a magnetic field and radio waves to create images of soft
tissues in the body. A contrast agent is a safe "dye" injected into the bloodstream that
can improve the imaging capability of the procedure. This procedure may enable your
pediatric urologist to locate a testicle in the groin or abdomen.
4. Laparoscopy
This procedure is generally considered the best choice for locating a nonpalpable
undescended testicle. Laparoscopy uses a tiny video device connected to a tube that a
surgeon inserts through a small incision in your son's abdomen. Images appear and can
be enlarged on a video screen. Surgical correction of the undescended testicle may be
done during the same procedure.
5. Open Surgery
Direct exploration of the abdomen through a larger incision may be necessary in a small
number of more complicated cases.

Das könnte Ihnen auch gefallen