Yaşar BOZKURT, Ahmet Ali SANCAKTUTAR, Yusuf KİBAR

İnmemiş testis ve eşzamanlı kasık fıtığı birlikteliği: Derleme

Skrotumda yer almayan testis için kriptorşidizm terimi kullanılır. Kriptorşid testisler ya yoktur veya inmemiştir. Kriptorşidizm, konjenital hastalıkları olan bebeklerde daha sık görülür ve en sık inmemiş testis şeklinde karşımıza çıkar. Miadında doğan erkek bebeklerin %2 ile %5’inde ve erken doğan bebeklerin ise %30’unda inmemiş testis bulunmaktadır. İnmemiş testislerin yaklaşık olarak %10’u çift taraflı olup en sık bulunduğu bölge eksternal inguinal halkanın hemen ağzıdır. İnmemiş testise en sık eşlik eden bozukluk inguinal herni olup, oluşumunda temel etken prosesus vajinalisin (PV) açık kalmasıdır. Primer inguinal herni, tüm yenidoğanların yaklaşık olarak %1 ile %5’inde görülür ve bu oran prematür doğan bebeklerde %9 ile %11’e kadar yükselir. Fıtığı olan bebeklerde genellikle semptom yoktur ve tedavi gerekiyorsa cerrahi işlem uygulanmalıdır. İnkarsere veya strangüle olan kasık fıtığı için acil ameliyat gerektiğinde, eş zamanlı inmemiş testis de eşlik ediyorsa orşiyopeksi yapılmalıdır. Ayrıca rutin orşiyopeksi yapılıyor ve inguinal herni de mevcutsa eş zamanlı herni tamiri de yapılmalıdır. Tedavi edilmeyen inmemiş testise eşlik eden bilinmeyen inguinal herniler, ilerleyen zamanda sıkışarak veya boğularak semptomatik hale gelebilirler. Kriptorşidik hastalarda görülen herni oranı tartışmalı bir konu olup değişik serilerde değişik yüzdeler bildirilmiştir. Yaptığımız literatür taramasında inmemiş testisli hastalara eşlik eden PV açıklığı ve inguinal herni oranlarının sırasıyla % 50 ve % 20 dolayında olduğunu gördük.

Undescended testis and the presence of concurrent inguinal hernia: A review

Cryptorchidism is defined as testes nonpalpabl in the scrotum. And they are generally undescended or aplastic. Cryptorchidism usually occurs among infants with congenital disorders and most cryptorchidic testicles are undescended. Between 2% and 5% of full-term and 30% of premature male infants are born with an undescended testicle. Approximately 10% of undescended testicle is bilateral and the most common location is just outside the external inguinal ring. Inguinal hernia that is characterized as patent prosesus vaginalis (PV) is the most common seen pathology concomitant to undescended testes. Primary inguinal hernia is present 1-5% of all infants. But this ratio rises up to 9-11% of premature babies. The patients are usually asymptomatic and the treatment needs surgical procedures. If urgent surgery is needed for incarcerated or strangulated inguinal hernia, orchiopexy procedure should be made together. In other conditions inguinal hernia requirement must be done during routine orchiopexy. The inguinal hernia with untreated undescended testes which is occult may become symptomatic or complicated such as incarceration or strangulation at any time. The incidence of inguinal hernia in the patients with undescended testes is controversial that different rates are reported in different series. According to our review of the literature, we determined that the rate of inguinal hernia and patent PV accompanying to undescended testes is 20% and 50%, respectively.

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