| What condition should be considered if bilateral undescended testis is accompanied by hypospadias? | Disorders of Sexual Differentiation (DSD) | Possibility of Disorders of Sexual Differentiation (DSD) to be considered if: • Bilateral undescended testis with hypospadias • Unilateral undescended testis with severe hypospadias Undescended testis with torsion – red painful lump in the undescended testis Undescended testis with large inguinal hernia TERTIARY CARE HOSPITAL PHC/ DISTRICT HOSPITAL July/ 2022 | 15 | relationship | 0.970 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726569367_undescended_testis.pdf | Possibility of Disorders of Sexual Differentiation (DSD) to be considered if: • Bilateral undescended testis with hypospadias • Unilateral undescended testis with severe hypospadias Undescended testis with torsion – red painful lump in the undescended testis Undescended testis with large inguinal hernia TERTIARY CARE HOSPITAL PHC/ DISTRICT HOSPITAL July/ 2022 | 1 | page=1,block=59 | 0.700 | valid |
| What is the guiding principle for diagnosing undescended testis? | Diagnosis made at birth and reconfirmed at 3 and 6 months. | ESSENTIAL INVESTIGATIONS • No investigation is essential for diagnosis or localisation of testis. • Routine blood and urine investigations required for anaesthetic fitness OPTIONAL INVESTIGATIONS • Hormonal test (HCG stimulation test for bilateral undescended testis ) • MRI scan in cases suspected to be DSD • Diagnostic laparoscopy in impalpable UDT (can be combined with therapeutic procedure) SPECIAL SITUATIONS • DSD: hormonal assay, USG, genitogram, karyotyping • Syndromic child: genetic assessment, karyotyping, hormonal assays • Undescended testis with torsion: USG Doppler Guiding Principle: Diagnosis made at birth and reconfirmed at 3 and 6 months. Further management if descent has not occurred. | 602 | summary | 0.970 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726569367_undescended_testis.pdf | • Routine blood and urine investigations required for anaesthetic fitness OPTIONAL INVESTIGATIONS • Hormonal test (HCG stimulation test for bilateral undescended testis ) • MRI scan in cases suspected to be DSD • Diagnostic laparoscopy in impalpable UDT (can be combined with therapeutic procedure) SPECIAL SITUATIONS • DSD: hormonal assay, USG, genitogram, karyotyping • Syndromic child: genetic assessment, karyotyping, hormonal assays • Undescended testis with torsion: USG Doppler Guiding Principle: Diagnosis made at birth and reconfirmed at 3 and 6 months. Further management if descent has |
| What are the routine investigations required for anaesthetic fitness in cases of undescended testis? | Routine blood and urine investigations | ESSENTIAL INVESTIGATIONS • No investigation is essential for diagnosis or localisation of testis. • Routine blood and urine investigations required for anaesthetic fitness OPTIONAL INVESTIGATIONS • Hormonal test (HCG stimulation test for bilateral undescended testis ) • MRI scan in cases suspected to be DSD • Diagnostic laparoscopy in impalpable UDT (can be combined with therapeutic procedure) SPECIAL SITUATIONS • DSD: hormonal assay, USG, genitogram, karyotyping • Syndromic child: genetic assessment, karyotyping, hormonal assays • Undescended testis with torsion: USG Doppler Guiding Principle: Diagnosis made at birth and reconfirmed at 3 and 6 months. Further management if descent has not occurred. | 100 | list | 0.820 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726569367_undescended_testis.pdf | • Routine blood and urine investigations required for anaesthetic fitness OPTIONAL INVESTIGATIONS • Hormonal test (HCG stimulation test for bilateral undescended testis ) • MRI scan in cases suspected to be DSD • Diagnostic laparoscopy in impalpable UDT (can be combined with therapeutic procedure) SPECIAL SITUATIONS • DSD: hormonal assay, USG, genitogram, karyotyping • Syndromic child: genetic assessment, karyotyping, hormonal assays • Undescended testis with torsion: USG Doppler Guiding Principle: Diagnosis made at birth and reconfirmed at 3 and 6 months. |
| What factors are considered in the evaluation and treatment planning for disorders of sex development (DSD)? | genotype, phenotype and psychological counselling | DSD- needs complete evaluation and treatment planning based on genotype, phenotype and psychological counselling Undescended testis with torsion – needs immediate exploration and orchiopexy/orchidectomy Undescended testis with large inguinal hernia- needs early surgery before waiting for 6 months due to the risk of obstructed hernia | 63 | list | 0.820 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726569367_undescended_testis.pdf | DSD- needs complete evaluation and treatment planning based on genotype, phenotype and psychological counselling Undescended testis with torsion – needs immediate exploration and orchiopexy/orchidectomy Undescended testis with large inguinal hernia- needs early surgery before waiting for 6 months due to the risk of obstructed hernia | 1 | page=1,block=15 | 0.700 | valid |
| What investigations are recommended for a syndromic child with undescended testis? | genetic assessment, karyotyping, hormonal assays | ESSENTIAL INVESTIGATIONS • No investigation is essential for diagnosis or localisation of testis. • Routine blood and urine investigations required for anaesthetic fitness OPTIONAL INVESTIGATIONS • Hormonal test (HCG stimulation test for bilateral undescended testis ) • MRI scan in cases suspected to be DSD • Diagnostic laparoscopy in impalpable UDT (can be combined with therapeutic procedure) SPECIAL SITUATIONS • DSD: hormonal assay, USG, genitogram, karyotyping • Syndromic child: genetic assessment, karyotyping, hormonal assays • Undescended testis with torsion: USG Doppler Guiding Principle: Diagnosis made at birth and reconfirmed at 3 and 6 months. Further management if descent has not occurred. | 487 | list | 0.820 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726569367_undescended_testis.pdf | • Routine blood and urine investigations required for anaesthetic fitness OPTIONAL INVESTIGATIONS • Hormonal test (HCG stimulation test for bilateral undescended testis ) • MRI scan in cases suspected to be DSD • Diagnostic laparoscopy in impalpable UDT (can be combined with therapeutic procedure) SPECIAL SITUATIONS • DSD: hormonal assay, USG, genitogram, karyotyping • Syndromic child: genetic assessment, karyotyping, hormonal assays • Undescended testis with torsion: USG Doppler Guiding Principle: Diagnosis made at birth and reconfirmed at 3 and 6 months. |
| What is the recommended follow-up schedule after surgery for undescended testis? | 1 month, 3 month, 1 year and annually till puberty | • Diagnose in newborn and reconfirm at 3 and 6 months: • If uncomplicated, counsel regarding timing of surgery and red flags • Basic lab investigations for anaesthesia fitness • Refer to centre with paediatric surgeon and paediatric anaesthesia facilities for surgery between 6m-1 yr • Assess for special situations – if present , refer immediately to centre with paediatric surgeon • After surgery follow –up at 1 month, 3 month, 1 year and annually till puberty • Diagnose or confirm diagnosis (if referred) early • Carry out open orchiopexy for palpable testis and laparoscopic exploration for impalpable testis under general anaesthesia at appropriate age • Identify red flag situations and investigate, counsel and operate accordingly • Follow-up- immediate and first week follow up Impalpable testis Undescended testis Palpable Open orchiopexy at 1 year by Paediatric Surgeon Palpate under GA Laparoscopic/open Orchiopexy Red Flags Signs-DSD/ torsion /syndromic Radiological, genetic and hormonal investigations Proceed with orchiopexy/orchidectomy and other procedures accordingly | 413 | list | 0.820 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726569367_undescended_testis.pdf |
| What is the recommended age range for performing orchiopexy? | between 6 months- 1 year (mostly at 1 year) | Surgery (orchiopexy) between 6 months- 1 year (mostly at 1 year) Palpable testis – open orchiopexy under general anaesthesia (may be done as day care procedure) Still Impalpable Impalpable: Diagnostic laparoscopy: Absent testis- no intervention; Atrophic testis: orchidectomy; if vas and vessels going into the deep inguinal ring: inguinal exploration; intra- abdominal tests: single or two stage orchidopexy. Inguinal exploration if access to laparoscopy is not available UDT: Undescended testes DSD: Disorders of sexual differentiation FU: Follow up GA: General anaesthesia | 21 | factual | 0.570 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726569367_undescended_testis.pdf | Surgery (orchiopexy) between 6 months- 1 year (mostly at 1 year) Palpable testis – open orchiopexy under general anaesthesia (may be done as day care procedure) Still Impalpable Impalpable: Diagnostic laparoscopy: Absent testis- no intervention; Atrophic testis: orchidectomy; if vas and vessels going into the deep inguinal ring: inguinal exploration; intra- abdominal tests: single or two stage orchidopexy. | 1 | page=1,block=42 |
| When is discharge typically expected after an open orchiopexy? | Discharge same evening/ next day | Open orchiopexy- Discharge same evening/ next day Laparoscopic orchiopexy- Discharge within 24-48 hours Further FU • 1st week- local edema/ hematoma/ tenderness • 1st, 3rd month- ensure testis position in scrotum and normal size • Annual examination – ensure position and adequate growth till adulthood • Adult FU for fertility status | 17 | factual | 0.570 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726569367_undescended_testis.pdf | Open orchiopexy- Discharge same evening/ next day Laparoscopic orchiopexy- Discharge within 24-48 hours Further FU • 1st week- local edema/ hematoma/ tenderness • 1st, 3rd month- ensure testis position in scrotum and normal size • Annual examination – ensure position and adequate growth till adulthood • Adult FU for fertility status | 1 | page=1,block=19 | 0.700 | valid |
| What procedure is performed for intra-abdominal testes? | single or two stage orchidopexy | Surgery (orchiopexy) between 6 months- 1 year (mostly at 1 year) Palpable testis – open orchiopexy under general anaesthesia (may be done as day care procedure) Still Impalpable Impalpable: Diagnostic laparoscopy: Absent testis- no intervention; Atrophic testis: orchidectomy; if vas and vessels going into the deep inguinal ring: inguinal exploration; intra- abdominal tests: single or two stage orchidopexy. Inguinal exploration if access to laparoscopy is not available UDT: Undescended testes DSD: Disorders of sexual differentiation FU: Follow up GA: General anaesthesia | 377 | factual | 0.530 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726569367_undescended_testis.pdf | Surgery (orchiopexy) between 6 months- 1 year (mostly at 1 year) Palpable testis – open orchiopexy under general anaesthesia (may be done as day care procedure) Still Impalpable Impalpable: Diagnostic laparoscopy: Absent testis- no intervention; Atrophic testis: orchidectomy; if vas and vessels going into the deep inguinal ring: inguinal exploration; intra- abdominal tests: single or two stage orchidopexy. | 1 | page=1,block=42 |
| How soon is discharge expected after laparoscopic orchiopexy? | Discharge within 24-48 hours | Open orchiopexy- Discharge same evening/ next day Laparoscopic orchiopexy- Discharge within 24-48 hours Further FU • 1st week- local edema/ hematoma/ tenderness • 1st, 3rd month- ensure testis position in scrotum and normal size • Annual examination – ensure position and adequate growth till adulthood • Adult FU for fertility status | 75 | factual | 0.490 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1726569367_undescended_testis.pdf | Open orchiopexy- Discharge same evening/ next day Laparoscopic orchiopexy- Discharge within 24-48 hours Further FU • 1st week- local edema/ hematoma/ tenderness • 1st, 3rd month- ensure testis position in scrotum and normal size • Annual examination – ensure position and adequate growth till adulthood • Adult FU for fertility status | 1 | page=1,block=19 | 0.700 | valid |