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Testículos intra-pélvicos : desafio cirúrgico
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A criptorquidia consiste na ausência da descida espontânea de um ou ambos os testículos para a bolsa escrotal homóloga, aquando do nascimento, consequência da ineficácia do processo de descida testicular que ocorre durante a vida fetal. É a patologia genitourinária mais comum em recém-nascidos do sexo masculino. A maioria dos testículos criptorquídicos são palpáveis em algum local, ao longo do seu trajeto (80%). Contudo, estima-se que cerca de 20% não conseguem ser identificados. Destes, cerca de 15-34% são intra-abdominais, os quais serão o foco deste trabalho, e geralmente estão localizados próximos aos vasos ilíacos, na cavidade abdominal ou próximos ao anel interno, na fossa ilíaca. Apesar da criptorquidia em si não provocar nenhum sintoma relevante, a sua correção cirúrgica precoce é importante devido aos riscos de complicações a curto e longo prazo. Os testículos intra-abdominais (TIA) correspondem a um grande desafio cirúrgico. A laparoscopia tornou-se no Gold Standard para identificar e tentar tratar os testículos não palpáveis com grande sensibilidade e especificidade, sendo o procedimento de Fowler-Stephens por via laparoscópica e em dois tempos um procedimento de rotina para TIA recomendado pelos consensos e diretrizes de especialistas nacionais e internacionais. Apresento o caso de um menino de 5 anos com o diagnóstico de criptorquidia bilateral e saliento o procedimento cirúrgico realizado no testículo direito, de localização intra-abdominal, o qual foi sujeito, aos dois tempos do procedimento de Fowler- Stephens. Partindo deste caso clínico, realizarei uma exposição do tema, com particular relevo para a etiologia, epidemiologia, clínica, diagnóstico, tratamento e follow-up dos testículos intra-abdominais. Os dados do caso clínico em questão foram obtidos através da consulta do processo clínico do doente e foi feita uma revisão da literatura relativa à criptorquidia.
Cryptorchidism is the absence of spontaneous descent of one or both testicles into the homologous scrotum at birth, because of the ineffectiveness of the process of testicular descent that occurs during fetal life. It is the most common genitourinary pathology in male newborns. Most cryptorchid testes are palpable somewhere along their course (80%). However, it is estimated that about 20% cannot be palpated. Of these, about 15-34% are intra-abdominal (they will be the focus of this work and are usually located close to the iliac vessels, in the abdominal cavity or close to the internal ring, in the iliac fossa.). Although cryptorchidism itself does not cause any relevant symptoms, its early surgical correction is important due to the risks of complications in the short and long term. Although cryptorchidism itself does not cause any relevant symptoms, its early surgical correction is important due to the risks of complications in the short and long term. IATs represent a major surgical challenge. Laparoscopy has become the Gold Standard for identifying and trying to treat non-palpable testes with great sensitivity and specificity, with the laparoscopic Fowler-Stephens procedure being a two-stage routine procedure for TIA recommended by the consensus and guidelines of national experts. I present the case of a 5-year-old boy diagnosed with bilateral cryptorchidism. The focus is on the treatment of his right testicle, intra-abdominal, subject to the two surgical stages of the Fowler-Stephens procedure. Starting from this clinical case, I will make an exposition of the theme, with particular emphasis on the etiology, epidemiology, clinic, diagnosis, treatment, and follow-up of intra-abdominal testicles. In order to carry out this thesis, the data of the clinical case in question were obtained by consulting the patient's clinical file and a review of the literature on cryptorchidism was carried out.
Cryptorchidism is the absence of spontaneous descent of one or both testicles into the homologous scrotum at birth, because of the ineffectiveness of the process of testicular descent that occurs during fetal life. It is the most common genitourinary pathology in male newborns. Most cryptorchid testes are palpable somewhere along their course (80%). However, it is estimated that about 20% cannot be palpated. Of these, about 15-34% are intra-abdominal (they will be the focus of this work and are usually located close to the iliac vessels, in the abdominal cavity or close to the internal ring, in the iliac fossa.). Although cryptorchidism itself does not cause any relevant symptoms, its early surgical correction is important due to the risks of complications in the short and long term. Although cryptorchidism itself does not cause any relevant symptoms, its early surgical correction is important due to the risks of complications in the short and long term. IATs represent a major surgical challenge. Laparoscopy has become the Gold Standard for identifying and trying to treat non-palpable testes with great sensitivity and specificity, with the laparoscopic Fowler-Stephens procedure being a two-stage routine procedure for TIA recommended by the consensus and guidelines of national experts. I present the case of a 5-year-old boy diagnosed with bilateral cryptorchidism. The focus is on the treatment of his right testicle, intra-abdominal, subject to the two surgical stages of the Fowler-Stephens procedure. Starting from this clinical case, I will make an exposition of the theme, with particular emphasis on the etiology, epidemiology, clinic, diagnosis, treatment, and follow-up of intra-abdominal testicles. In order to carry out this thesis, the data of the clinical case in question were obtained by consulting the patient's clinical file and a review of the literature on cryptorchidism was carried out.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2023
Palavras-chave
Testículo intra-abdominal Orquidopexia Procedimento cirúrgico de Fowler-Stephens Pediatria