Praveenkumar, C P (2020) Prospective study on Surgical Management of Undescended Testis in a Tertiary Hospital. Masters thesis, Government Vellore Medical College, Vellore.
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Abstract
INTRODUCTION: Undescended testis is one of the most common surgical problems encountered among paediatric age group. Undescended testis, age of diagnosis plays important role in outcome. In clinical examination of groin and scrotum, palpable testis and non-palpable testis can be categorized. Based on palpable or non-palpable patients management course differs. If retractile testis treatment plan altered, however managed conservatively and monitored periodically. Open Orchidopexy is done for palpable testis and laparoscopic surgeries are done for non-palpable testis .Ultrasound imaging plays a role in locating non-palpable testis and assessing testicular volume. Undescended testis, if left untreated can result in malignancy, infertility, psychological problems, testicular trauma, and torsion testis. Early diagnosis and treatment is of paramount importance. Undescended testis associates with other anomalies such as congenital inguinal hernia, hypospadias and sexual disorders. This study will present a correlation between presentations, management mainly concentrating on surgical management and outcome of undescended testis patients in Government Vellore Medical college. AIMS AND OBJECTIVES: 1. To study the clinical presentation of undescended testis as regards to age, position, side and symptoms. 2. To study the management on undescended testis. 3. To study laparoscopic management of undescended testis, single staged or double staged. 4. To study correlation of preoperative ultrasound imaging, testicular atrophic index and intraoperative findings of undescended testis. MATERIALS AND METHOD: SOURCE OF DATA: It includes the patients admitted for undescended testis and related surgically in Government Vellore Medical College Hospital, in Department of General Surgery. 50 positive finding cases of undesended testis Taken for study. Those Patients diagnosed with undescended testes, Patients willing for surgery and upper age limit Is upto 16 years of age are included in the study. Those Patients with retractile and ectopic testis, Patients not willing/ unfit for surgery, Patients with bilateral non-palpable undescended testis are not included. In this study, patient brought by their parents for Undescended testis divided into two groups, Group A - palpable undescendend testis for open Group B - non-palpable undescendent testis, opting for laparoscopic management in which undergoes single and double staged treatment. Testicular atrophy index is a valuable and objective tool for assessment of the state of development of the testis at every stage of UDT treatment. In this study preoperative Testicular atrophic Index is used to predict outcome of vanishing testis. RESULTS AND OBSERVATIONS: Total of 50 patients participated in this study. All the patients were selected randomly. The study was conducted for the period of 12 months from October 2018 to September 2019. In our hospital, admitted out of 50 patients, 40 patients (80%) with palpable undescended testis, 10 patients with non-palpable testis (10%). Among 40 patients of palpable undescended testis patients, 52% (n= 21/40) of palpable testis patients with right sided presentation, 33% (n=13/40) of patients with left sided presentation, 15% (n=6/40) of patients with bilateral presentation. In 10 patients of Non-palpable testis, 30 % (n=3/10) of non-palpable testis patients with right sided presentation, 70% (n= 7/10) of palpable testis patients with left sided presentation. In palpable undescended testis, mean age of presentation is 8 years, among undescended testis, mean age of presentation is 7 years, smallest among them is 10 month child, largest is 15 years of age.in non-palpable testis, mean age of presentation is 10 years. Earlier age presentation in palpable undescended testes, comparatively late age presentation in non-palpable UDT. Odds ratio with Confidence Interval 95%, p value = 0.000 (< 0.05). Testicular atrophic index (preoperative USG) for both palpable and non-palpable testis patients compared with intraoperative findings of normal testes and vanishing testes, TAI value less than 20 % taken as low and more than 20% as high, thus with high testicular index for three patients with vanishing testes syndrome. TAI with high index can predict vanishing testis syndrome with p value 0.00 (< 0.05). CONCLUSION: Undescended testis, one of the most common congenital disease, In this study right side as most common side of presentation, with earlier age presentation in palpable undescended testis and In non-palpable undescended testis with late age presentation. Among palpable and non-palpable Undescended testis, palpable is more common than non-palpable undescended testis. Vanishing testis in non-palpable testis of about 8% incidence with preoperative Ultrasound predicts vanishing testis by Testicular atrophic index if more than 60%. Associated congenital anomalies in this study was phimosis, hypospadias and congenital inguinal hernia was studied. Approximately 10 percentage of tumor occurs in testes with maldescended testis. However testicular malignancy and in fertility could not be studied in this study as needed long duration for follow up.
| Item Type: | Thesis (Masters) |
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| Additional Information: | 221711657 |
| Uncontrolled Keywords: | Surgical Management, Undescended Testis, Tertiary Hospital, Prospective study. |
| Subjects: | MEDICAL > General Surgery |
| Depositing User: | Subramani R |
| Date Deposited: | 12 Feb 2021 17:43 |
| Last Modified: | 12 Feb 2021 17:43 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/14079 |
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