Congenital anomalies of the testes

Cryptorchidism

Cryptorchidism is the failure of one or both testicles to descend into scrotum. Untreated, it increases the risk for testicular cancer, infertility, and testicular torsion.

1% of boys
- It’s the most common congenital anomaly of genitourinary tract
Risk factors
- Prematurity
Diagnosis
- Testis cannot be palpated in the scrotum
Treatment
- Many spontaneously descent, but not after 6 months
- Within 6 – 18 months
- Orchidopexy
- Laparoscopic surgery

Congenital hydrocele

Congenital hydrocoele is a fluid collection between the layers of the tunica vaginalis.

Causes painless, enlarged scrotum
Usually resolves spontaneously
Requires surgery if it persists beyond 12 months

Ectopic testes

Testes is located outside the normal path of descent
Increases risk of cancer and infertility
In superficial inguinal pouch, perineum, femoral canal, suprapubic region
Treatment is orchidopexy

Congenital varicocoele

Varicocoele, the abnormal enlargement of the pampiniform plexus in the scrotum due to obstruction of the spermatic vein, can be congenital/primary. It almost always affects the left testicle. It's an under-recognised cause of male infertility. It causes pain in the affected testicle and painless swelling. Surgery may be indicated in case of pain or infertility.

Congenital anomalies of the bladder

Bladder extrophy

Male > female
Bladder is herniated through defect in abdominal wall
Associated with separation of pubic bones
Treatment: surgery

Congenital anomalies of the urethra

Posterior urethral valve

= tissue which obstructs the posterior urethra
Common cause of urinary tract obstruction in newborn males
- Only affects males
Associated with pulmonary hypoplasia
Diagnosis by voiding cystogram
Treatment: Valve ablation with cystoscopy

Hypospadias

External urethral opening on ventral penis
Only symptomatic cases require surgery

Epispadias

External urethral opening on dorsal penis
Often associated with bladder exstrophy
Treatment: surgery