(PDF) Torsion of undescended testis: Clinical, imaging ... This study was aimed to determine the diagnostic accuracy of diffusion-weighted magnetic resonance imaging (DW-MRI) in localization of undescended testes taking laparoscopic findings as the gold standard. T1 and T2 weighted axial and coronal sequences, especially with a small field of view (FOV) are advisable as well as diffusion weighted imaging. Case submitted by Dr MGK Murthy. Cryptorchidism is found in 3.5% of term male infants at birth. This patient has left undescended testes just beyond the deep ring locaised on MRI imaging. However, in a 2011 meta-analysis it was concluded that ultrasound does not reliably localise non-palpable testes and cannot rule out intra-abdominal testes. Retractile testis . Even for palpable testes, Elder et al. Etiology: testicle does not descend from abdomen to inguinal canal into scrotum Imaging: look up along path of testicular descent from scrotum up to inguinal canal up to abdomen to underneath kidney Clinical: 3-4% of newborns have undescended testicle, 1% of 1 year olds have undescended testicle, to prevent increased incidence of testicular cancer and infertility have orchiopexy performed by 1 . Ultrasound in the Evaluation of Retractile and Truly ... 5. Undescended Testicles and the Use of Ultrasound - The Checkup Ultrasound revealed the left testis and epididymis in left inguinal region near the deep inguinal ring. Associated urologic anomalies can be seen in up to 20% of patients with an undescended testis. A coronal ultrasound view using a curvilinear probe provides a good comparison and overview of both sides. The aim was to study the position of undescended testes by high frequency ultrasound and its embryonic explanation. False-positive diagnoses were not made with either modality in the . Recent studies suggest that DW imaging may also aid in localization, since the undescended testicle is frequently . There were thirty two patients, aged 1.5 . In many cases an exploratory laparotomy has been performed although even this has . Undescended Testes MRI. MRI with ultrasound for detection of undescended testes and prevent children from hazardous rays of MRI. lack of a testis in the scrotal sac the undescended testis is a homogeneously hypoechoic ovoid structure, similar to the contralateral testis, with an echogenic mediastinum testis the ectopic testis may be . Twelve cryptorchid patients had sonographic evaluation of the inguinal region prior to surgical orchiopexy. reported poor . • Ultrasound imaging is not indicated for a palpated undescended testicle • Surgical intervention for most patients once 6 months age (corrected for gestational age) • If medical comorbidities, delayed intervention often considered • Medical therapies (LHRH and/or hCG) are not considered standard of care in the United States The majority of UDTs are located in the inguinal canal . PURPOSE: To evaluate the testes, epididymis, and scrotum for abnormalities. The word is from the greek κρυπτός (kryptos), meaning hidden, and ὄρχις (orchis . An UDT will return to pre-scrotal position, a retractile testicle will remain in scrotum. The undescended testis is most commonly located at or just below the . The sensitivity was found to be 45%, with a specificity of 78% [3]. One hundred and twenty-three undescended testicles were examined. Ultrasound imaging of the scrotum is the primary imaging method used to evaluate disorders of the testicles, . Magnetic resonance imaging for detection of non palpable undescended testes: Diagnostic accuracy of diffusion-weighted MRI in comparison with laparoscopic findings Ehab Ali Abd-ElGawad a,*, Enas . Ultrasound is the most useful modality for localisation of the intraabdominal undescended testis. The aim of this study was to evaluate ultrasound and clinical examination in the assessment of the exact position of an undescended testicle, and to see whether ultrasound could help discern retractile and truly undescended testicles. INDICATIONS: • Signs (examples: mass, swelling) or symptoms (example: pain) associated with the scrotum • Undescended testes • Evaluate for testicular malignancy . CT is commonly used by clinicians to assess cryptorchidism. An X-ray or ultrasound imaging test may help your child's doctor diagnose an undescended testicle. Ultrasound may misdiagnose a retractile testis as an undescended testis. Of 16 undescended testes, 15 were . Undescended testis (UDT) is the second most common paediatric surgical condition after inguinal hernias. Up to one third of premature male newborns are born with an undescended testicle, and 3 to 5 percent of term male infants are affected.12 By three . In most cases, the aetiology is unknown. Given the poor ability to localize nonpalpable testes, ultrasound has no role in the routine evaluation of boys with cryptorchidism . Imaging scans, including an MRI with contrast dye, can confirm the presence or absence of his testicle. There was one false-negative diagnosis by CT and two by ultrasound. The management of undescended testes is one of the most controversial aspects in pediatric urology. Colour Doppler should be used to assess for . More precise communication on how radiology for undescended testis affects paediatric urologists' practice is important so that a greater number of referring clinicians understand the reasons why, for instance, an ultrasound for an undescended testis has the potential to create problems along the line. Diagnostic laparoscopy has been established as the most reliable diagnostic technique for localizing nonpalpable testes with nearly 100% sensitivity and specificity 1, 14 . One hundred and twenty-three undescended testicles were examined. The undescended testis is the most common genital malformation in boys and should be treated before the child's first birthday. Of 113 detectable testicles 47 were assessed retractile and 66 truly undescended of which 60 . Normal testis ultrasound using a curvilinear probe for accurate measurements or to provide a more global view including surrounding anatomy and pathology. The undescended testes were unilateral in eight patients (one had testicular duplication) and bilateral in four. The increased risk of malignancy has not been proven in undescended testes that reach the level of the groin (there appears to be a slight increased risk of malignancy for intra-abdominal testis). The accuracy rates of diagnosis and localization of a nonpalpable testis with MRI (85%) and ultrasound (84%) are nearly equally with no statistically significant differences 13, 14. × Discussion. SCOPE: Applies to all ultrasound scrotal studies performed at Imaging Services / Radiology . Providers should not perform ultrasound (US) or other imaging modalities in the evaluation of boys with cryptorchidism prior to referral, as these studies rarely assist in decision making. Abstract Background: Undescended testis is a well recognized clinical problem in infants and young male , as well as being a . In six patients the presence or absence of testicular tissue was predicted correctly prior to surgery. Imaging Ultrasound, CT, and MRI not recommended for non-palpable testicles. In our study out of total 52 undescended testes 46(88%) could be located by ultrasound. Computed tomography (CT) scanning and ultrasonography yield high false-negative rates in the evaluation of a . The Diagnostic Imaging unit, upon receipt of an US order for suspected undescended testis from a primary care provider, sends a letter stating that US may not be necessary and recommending referral to a pediatric urologist or pediatric general surgeon instead of imaging. Testis-fat contrast at 0.35 T was optimal with a short repetition time (TR) and a short echo time (TE). The non-palpable testis is uncommon (less than 10 per cent) with approximately half of these atrophic. Abstract. Radiologic studies to localize the testis are of very little value. Magnetic resonance (MR) imaging was performed in 32 male patients, 20 with no abnormalities and 12 with clinically suspected undescended testes. Cryptorchidism (undescended testis [UDT]) is one of the most common congenital disorders in pediatrics. Ultrasound - Scrotal Evaluation . When the testis was within the inguinal canal, the gonad was localized preoperatively by sonography in eight of nine patients. Retractile testis is defined as a testis of normal size that reaches the bottom of the scrotum without . The undescended testis is also often smaller, as in this case (3.5 cm vs 2.4 cm). If left untreated, this condition can lead to an . However, ultrasound imaging is limited in visualising testes that are not superficial in location. We studied the usefulness of radiography for localization of cryptorchid testes. A doctor may recommend a testicular ultrasound to: determine the outcome of . The clinical symptoms of undescended testis torsion include nonspecific abdominal pain, poor oral intake, vomiting, and restlessness. ULTRASONOGRAPHY IN UNDESCENDED TESTES T. E. BJERKLUND JOHANSEN and A. LARMO Abstract The position of an undescended testicle is of importance for choice of therapy. Abdominal scrotal ultrasound can be useful for confirming testes in an inguinal position and also for obese patients [3]. Undescended testis (UDT) is the second most common paediatric surgical condition after inguinal hernias. The management of undescended testes is one of the most controversial aspects in pediatric urology. Ultrasound has 45% sensitivity, 78% specificity, and 88% accuracy for localization of undescended testis and is more accurate than clinical examination 4,5. lack of a testis in the scrotal sac; the undescended testis is a homogeneously hypoechoic ovoid structure, similar to the contralateral testis, with an echogenic mediastinum testis Undescended testes (UDTs) are a relatively common finding in newborn males, especially in those born prematurely. One patient had an associated inguinal hernia in which loops of bowel concealed the gonad. One intraabdominal testis was not seen. The diagnosis of the entity depends mainly on laparoscopy and the role of imaging is controversial, though diagnostic imaging has been considered to be helpful particularly for the evaluation of patients with a nonpalpable undescended testis. Undescended Testicles and the Use of Ultrasound. The testis was identified and correctly localized 16 times by CT and 15 times by ultrasound. The testis is typically low signal on T1 and high signal on T2. 4. The presence of an echogenic central structure within an . The aim of this study was to investigate Resonance Imaging in comparison with Ultrasound (1)Muna A.G , (2)Najlaa Hanon , (3)Riadh H (1)(2) Radiologist in Al-Yarmouk Teaching Hospital(3) Radiologist in Central Pediatric Hospital (1)(2) AL- Mustansiriyah University Key wards: Undescended testis, ultrasound, MRI. It is very important to perform adequate genitourinary examinations, including a testicular examination in the emergency department (ED), as this may prevent missing the diagnosis . In 2013, an evidence‐based statement on undescended testes was released jointly by . The problem is not, in principle, the time to bring the testis down to the scrotum, but whether and when to perform imaging studies such as ultrasound (US) and why we still get the patients with undescended testis at a later age than global recommendations for orchidopexy. [7, 8] Ultrasonography is the first imaging modality performed on a cryptorchid testis.Of cryptorchid testes, 72% are in the inguinal canal. Upon discovering a non-intrascrotal testis, it is important to determine whether the testis is palpable or non-palpable and whether the finding is unilateral or bilateral. If the testicle is palpable, ultrasound does not change clinical management since the decision to proceed with treatment (surgery) is based on history and physical examination by the surgeon. UDT is reportedly 10 times more likely to torse, although there are only a few published cases of UDT torsion. Coronal T1W images can show the gubernaculum testes and spermatic cord, which can be followed to locate the undescended testes. Luciano studied 133 cryptorchid . Cryptorchidism, undescended testes, is a pathological condition that is due to failure of descent of testes in the scrotum. The accuracy of imaging testing for detection of undescended testis is about 40% [9]. 2. Abdominal scrotal ultrasound can be useful for confirming testes in an inguinal position and also for obese patients [3]. Investigation of Undescended Testes AHMED M. OUF, M.D. 1 Five per cent of boys have a UDT at birth, 1-2% at three months and 1% at one year; hence, it is uncommon for testes to descend after three months. Cryptorchidism or undescended testis (UDT) is the most common urological birth defect, occurring in 1 in 33 live male births. The Department of Radiology, Faculty of Medicine, Al Azhar University. The undescended testicle might be smaller in volume and slightly hypoechoic in structure by ultrasound imaging compared to the normal testicle. Undescended testes (UDT) are a common finding in the neonatal period. Total 41 boys with undescended testes underwent high frequency ultrasound. Undescended testis (UDT) is defined as failure of a testis to descend into the scrotum and it is a common reason for consultation in pediatric urology. It is treatable with antibiotics. Further evaluation with computed . It allows for the clear distinction between a retractile testis and palpable and impalpable undescended testes. American Urolological Association guidelines recommend against imaging studies in boys with cryptorchidism prior to surgical referral. Out of 46 tes- tes located by ultrasound 5(10%) were retractile, out of remaining 41, 26 (63%) were in inguinal canal, 15 (37%) were located in abdomen. The overall accuracy of radiologic testing for undescended testis is only 44%. Radiology plays an important role, predominantly in the assessment of the nonpalpable testis, with ultrasound being the most commonly employed modality. Cryptorchidism is usually unilateral, but up to 30% of cases are bilateral. Radiographic features Ultrasound Ultrasound has 45% sensitivity, 78% specificity, and 88% accuracy for localization of an undescended testis and is more accurate than Clinical examination. Ultrasound is the most imaging modality most commonly used to evaluate boys with undescended testes . 3. To assess accuracy of ultrasound and MRI in comparison with laparoscopy in detection of non-palpable undescended testes. The most important reasons for surgical treatment of cryptorchidism include increased risks of testicular malignancy, infertility, testis torsion and/or inguinal hernia. Observations included location of the undescended testis, size (length × width) and . A retractile testicle is one that moves back and forth between your child's groin and his scrotum. A sudden onset of pain in the scrotum should be taken very seriously. Our study enrolled 42 patients with 49 non-palpable undescended testes from October 2014 to October 2020 in the Urology-Department of Al-Sader Medical City, Najaf. The palpable UDT should be defined by the . Ultrasound is the most heavily used imaging modality to evaluate undescended testes. Undescended testis or cryptorchidism, a . There is no role for pre-referral radiological imaging in children with undescended testes. Magnetic resonance imaging is however the . Imaging should not be used in this workup, as no current modality has been shown to be adequately sensitive or . As extensively discussed in "The undescended testis in children and adolescents: part 1", the failure of a testis to descend alters testicular germ-cells development, increasing the risk of infertility and testicular cancer in adulthood . Undescended testis or cryptorchidism is a common congenital anomaly affecting about 2-8% of boys in population studies in Europe.1 In the UK, about 6% of boys have an undescended testis at birth.2 . [] The American Urological Association (AUA) recommends that a scrotal ultrasound not be performed in the preoperative management of cryptorchidism. A total of 23 radiographic studies ordered by referring physicians was done for testis . Introduction. Due to the varied performance of imaging techniques, we meta-analyzed data from a larger Agency for Healthcare Research and Quality-funded systematic review of evaluation and treatment approaches for cryptorchidism 6 to assess the performance of a commonly used imaging technique (conventional [T1-, T2-weighted] MRI) for identifying and locating nonpalpable undescended testicles. The most important reasons for surgical treatment of cryptorchidism include increased risks of testicular malignancy, infertility, testis torsion and/or inguinal hernia. We describe the computed tomographic (CT) and magnetic resonance (MR) findings in 2 patients with malignant change in . Patients and Methods . They . R L Hrebinko, M F Bellinger. However, the most important limitation of ultrasound is its ability to accurately localize undescended testes. FROM THE SECTION OF UROLOGY, DEPARTMENT OF SURGERY, AND THE DEPARTMENT OF RADIOLOGY. (Standard; Evidence Strength: Grade B) Discussion. The testis and epididymis showed altered echotexture with no vascularity on colour doppler and power doppler settings. In the hands of an experienced provider or specialist, more than 70% of cryptorchid testes are palpable by physical examination and need no . Imaging features of nontorsed undescended testis were compared with a case of an inguinal torsed testis. The normal testis exhibits intense diffusion . Ultrasound of normal testicular vascularity with colour doppler in a post pubescent case. AKERSHUS CENTRAL HOSPITAL, N-1474 NORDBYHAGEN, NORWAY. Two conditions can mimic an undescended testicle. Educational updates, local education programmes, and national campaigns have been helpful . Surrounding tunica albuginea was thickened with reactive hydrocele. 8100860. Cryptorchidism - Presentation1 Radiological Imaging Of Undescended Testis / Cryptorchidism is the absence of one or both testes from the scrotum.. Cryptorchidism is transmitted in a multifactorial pattern. Cryptorchidism is often the cause of the disruption of the hormonal and reproductive function of. The first diagnostic laparoscopy for impalpable testes in 1976 [10]. No vascularity was seen in the spermatic cord. At MR imaging, the undescended testicle has signal characteristics similar to those of testicles in the scrotum (ie, hyperintense on T2-weighted images and hypo- to isointense on T1-weighted images). a nonpalpable testis with MRI and ultrasound are equally moderate (85% and 84%) [4, 8]. The aim of this study was to evaluate ultrasound and clinical examination in the assessment of the exact position of an undescended testicle, and to see whether ultrasound could help discern retractile and truly undescended testicles. Diagnostic imaging has no role in the management of undescended testes. Of 113 detectable testicles 47 were assessed retractile and 66 truly undescended of which 60 . 1. Various imaging methods have been used in the past with only partial success. Cryptorchidism or undescended testis (UDT) is the most common urological birth defect, occurring in 1 in 33 live male births. Imaging studies such as Doppler ultrasonography, CT, and . Most undescended testicles are present at birth. The . This condition typically subsides as . The limited role of imaging techniques in managing children with undescended testes. A diagnosis of chronic torsion/ infarct of the undescended . Aim of the study To assess accuracy of ultrasound and MRI in comparison with laparoscopy in detection of non-palpable undescended testes. Imaging scans, including an MRI with contrast dye, can confirm the presence or absence of his testicle. Abstract Location of undescended testis is important because of the greatly increased risk - of malignancy. Diagnostic Performance of Diffusion-Weighted MRI in the Detection of Nonpalpable Undescended Testes: Comparison With Conventional MRI and Surgical Findings Mecit Kantarci1 Selim Doganay2 Ahmet Yalcin1 Yilmaz Aksoy3 Bahar Yilmaz-Cankaya1 Bedii Salman4 Kantarci M, Doganay S, Yalcin A, Aksoy Y, Yilmaz-Cankaya . US is the most common diagnostic imaging study employed in the evaluation of cryptorchidism. Preoperative localization of the impalpable undescended testis is necessary to facilitate proper surgical planning. A testicular ultrasound is the primary imaging method used to observe and diagnose abnormalities in the testicles. However, in a 2011 meta-analysis it was concluded that ultrasound does not reliably localise non-palpable testes and cannot rule out intra-abdominal testes. Localization of an undescended testis was attempted in 23 instances in 20 patients using both computed tomography (CT) and high-resolution real-time ultrasonography. At 1.5 T, good contrast was achieved with short TR/TE sequences, but . The spermatic cord or gubernaculum testis can be followed to aid in localization. US TESTICLE PROTOCOL . Magnetic resonance imaging for detection of non palpable undescended testes: Diagnostic accuracy of diffusion-weighted MRI in comparison with laparoscopic findings Ehab Ali Abd-ElGawad a,*, Enas . We describe our experience of prospective magnetic resonance imaging (MRI) study in patients of undescended testis, with a 1.5 T equipment using body coil. A testicular ultrasound is the primary imaging method used to observe and diagnose abnormalities in the testicles. × Discussion. Undescended Testicles and the Use of Ultrasound. Ultrasound is noninvasive and does not use ionizing radiation, which makes it an attractive imaging study for children. An X-ray or ultrasound imaging test may help your child's doctor diagnose an undescended testicle. Magnetic resonance imaging was used to evaluate seven patients with undescended testes. Once testis palpated, bring to scrotum and hold for short time to fatigue the cremasteric muscles and then release. Ultrasound tops the list of imaging studies for obvious advantages like availability, non-invasive nature and low cost. Physical examination findings include inguinal swelling and erythema with a firm, tender mass in the inguinal region and an empty ipsilateral hemiscrotum. No surgery is required. An undescended testis is one of the most common genitourinary anomalies in male infants. • Ultrasound imaging is not indicated for a palpated undescended testicle • Surgical intervention for most patients once 6 months age (corrected for gestational age) • If medical comorbidities, delayed intervention often considered • Medical therapies (LHRH and/or hCG) are not considered standard of care in the United States The majority of UDTs are located in the inguinal canal . (Standard; Evidence Strength: Grade B) Discussion. This is due to activation of cremasteric reflex by the ultrasound probe displacing the testis toward the groin. A doctor may recommend a testicular ultrasound to: determine the outcome of . 9,10. 1-3 To the Editor: Undescended testis affects 2-4% of term male newborns.1 Clinical examination by an experienced clinician remains the most accurate method of assessing the position of the testis. This condition typically subsides as . Orchidopexy (surgical correction to reposition the testis) is ideally done between 6 and 18 months of age . The technique is accepted as the first step after clinical . 1 It refers to a testis that is not in the scrotum by the age of three months because of a failure of normal descent. The primary care provider may then choose to either follow the letter's recommendation or re-request the US at our . Imaging is indicated in all patients with cryptorchidism prior to surgery. Two conditions can mimic an undescended testicle. The age of those patients ranges from 1 year to 12 years (mean 4.2 years). 1. Ultrasound (US) is the most common diagnostic imaging study employed in the evaluation of cryptorchidism and can reliably identify a cryptorchid testis lying below the level of the internal inguinal ring. 1 Introduction. Ultrasound has variable ability to detect palpable testes and has an estimated sensitivity and specificity of 45% and 78%, respectively, to accurately localize nonpalpable testes. If medicinal therapy (LHRH and hCG) is ineffective, orchidopexy should be performed immediately to reduce the risk of further damage to the . No radiologic intervention exists. The presence of a mediastinum testis (a longitudinal echogenic band) is diagnostic for the maldescended testis. In the hands of an experienced provider or specialist, more than 70% of cryptorchid testes are palpable by physical examination and need no . Journal of Urology 1993, 150 (2 Pt 1): 458-60. Spermatic cord structures, if present, were accurately visualized in all patients. Ultrasound is the initial imaging modality to visualise, as well as localise the testis in cryptorchidism. Keywords: Undescended testes, cryptorchidism, ultrasound, magnetic resonance imaging, male children INTRODUCTION Cryptorchidism or undescended testes is an embryological anomaly resulting in the failure of testicular descent into the scrotal . As an imaging technique, sonography with a high-resolution transducer (>7.5 MHz) provides a correct classification rate . Patients and Methods Our study enrolled 42 patients . Background. MRI is the best cross-sectional modality to assess crypto-orchidism. It affects up to one in 20 term males and up to one-third of preterm males. Providers should not perform ultrasound (US) or other imaging modalities in the evaluation of boys with cryptorchidism prior to referral, as these studies rarely assist in decision making. The results were compared with ultrasonographic, computed tomographic, clinical, and surgical findings. The problem is not, in principle, the time to bring the testis down to the scrotum, but whether and when to perform imaging studies such as ultrasound (US) and why we still get the patients with undescended testis at a later age than global recommendations for orchidopexy. 1-3 There is an increased incidence of malignant change in the undescended testis; demonstration of malignancy before surgery will significantly alter the treatment. A common cause of scrotal pain is epididymitis, an inflammation of the epididymis. The cryptorchid testis is typically heterogeneously hyperechoic at ultrasound assessment. Of 16 undescended testes, 15 were correctly identified on MR images. Ultrasound may be indicated in the obese child Laboratory . The UDT may be best classified as palpable or non-palpable. This article highlights various examples of abnormal descent of the testis in usual as well as unusual locations and complications of undescended testes. The goals were to determine current referral patterns for boys suspected of having undescended testis (UDT) and to identify factors to assist primary care providers in distinguishing retractile testes from UDTs on the basis of history, physical examination, . The sensitivity was found to be 45%, with a specificity of 78% [3]. The undescended testes were unilateral in eight patients (one had testicular duplication) and bilateral in four. 1 It refers to a testis that is not in the scrotum by the age of three months because of a failure of normal descent. A retractile testicle is one that moves back and forth between your child's groin and his scrotum. look for the location of undescended testis. 42 US is an ideal imaging modality for several reasons: most undescended testis lie within the inguinal canal and are therefore readily accessible to evaluation; there is no ionizing . 1 Five per cent of boys have a UDT at birth, 1-2% at three months and 1% at one year; hence, it is uncommon for testes to descend after three months.
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