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Male Reproductive System

Cryptorchidism: causes, treatment, surgery

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Cryptorchidism - a congenital disorder, which is characterized by failure of the testes or testicles in the scrotum. It is more common in premature boys (20 - 40% of cases). Sometimes, in spite of the advances of medicine, meets and cryptorchidism in adults.

Kinds

Localization undescended testes secrete

  • inguinal (ingvanalny) when an egg / testicles arranged in the inguinal canal
  • abdominal (peritoneal) cryptorchidism, when the egg is situated in the abdominal cavity.

Furthermore, isolated

  • true cryptorchidism (testicles do not fall into the scrotum after being relegated)
  • false cryptorchidism (testicles are in the scrotum, but due to muscle contraction, lifting egg them after inspection or exposure to cold return from the scrotum to the inguinal canal).

False cryptorchidism disappear on their own after 2 years. There is also an ectopic testis, which is characterized by deviation of eggs from its natural path sequence in the scrotum (in this case, the egg can be located in the pubic area, thighs or beneath the skin in the inguinal area).

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If the testicles are not descended one testicle, saying a unilateral cryptorchidism, when the scrotum absent both testicles - is a bilateral cryptorchid.

The absence of one testicle in the body at all - it monorchism, and both - anorchia.

The causes of cryptorchidism

For prospective development of disease factors include:

  • chromosomal abnormalities of the fetus during pregnancy against chemical factors (inhalation of paint during renovation work in hazardous work) or viral (influenza, rubella, toxoplasmosis, Infections, sexually transmitted diseases);
  • hormonal disorders in the mother and fetus;
  • intrauterine growth retardation (placentofetal failure, placenta previa);
  • mechanical obstructions from entering the testis into the scrotum (the slow growth of the spermatic cord);
  • alcohol intake, smoking during pregnancy;
  • miscarriage (Up to 37 weeks);
  • simultaneous reception of several nonsteroidal antiinflammatory drugs (paracetamol, aspirin, ibuprofen);
  • genetic predisposition (the father, the brothers have a history of cryptorchidism);
  • Down's syndrome and other chromosomal disease;
  • reduced intra-abdominal pressure in the fetus during pregnancy.

symptoms

Testicles during fetal development are a long way from the abdomen into the scrotum. Therefore, the main symptom of cryptorchidism will lack one or both testicles in the scrotum.

Depending on where in they "delayed", testicles or palpated in the inguinal canal (groin cryptorchidism) or not (presumptive diagnosis: abdominal cryptorchidism).

Another feature of the disease is asymmetric or empty scrotum. Often combined with cryptorchidism inguinal hernia and / or hypospadias.

Hypospadias - is a fetal malformation, which is characterized by an arrangement of the urethra is not at the head of the penis and on the back wall. In addition, patients may disturb the aching pain in the lower abdomen and groin. Most of the children on their own testicles descend into the scrotum by 6-9 months (treatment is indicated in undescended testes to 1 year).

Cryptorchidism in adults

The disease in adults - a rare phenomenon. Perhaps as a child due to any reason the operation was contraindicated (systemic diseases, heart disease, poor clotting blood) or the patient subsequently injured genitals, causing the displacement of the testis from the scrotum to the inguinal canal or abdominal cavity.

Treatment of adult surgery alone, and most of it ends up removing the testis / testes. Cryptorchidism in adults has a high degree of malignancy testis, infertility, impotence.

Diagnostics

Palpation is determined by the absence of egg / testis in the scrotum, with inguinal cryptorchidism they palpated in the inguinal channel, when not palpable abdominal form.

In the diagnosis of disease using instrumental methods: ultrasound of the scrotum and abdominal computed tomography (CT) And nuclear magnetic resonance (NMR).

In the case of possible hormonal disorders blood tests are assigned to hormones.

In bilateral cryptorchidism should be differentiated from anorchia. To conduct this test with Chorionic gonadotropin and contrast angiography (introduction into the vessels of the scrotum of contrast medium followed by radiography).

Treatment of cryptorchidism in children

Treatment of the disease is carried surgeon urologist. Allocate conservative treatment and surgical treatment.

When conservative therapy appointed hormones (hCG or corticotropin releasing factor). Total held 3 - 5 injections once a week.

Conservative treatment does not always help and often administered in bilateral cryptorchidism as a preparatory phase of the operation.

Side effects of hormone therapy appear darkening of the scrotum, the appearance of hair in the pubic area, the penis enlargement. After discontinuation of therapy, all symptoms disappear.

Operation

Surgical treatment is performed in the first 2 years of a child's life (not before fulfillment of his year). Moreover, the previously performed surgical correction, the lower the percentage of the possible complications of this disease.

The operation of "return" of the testicles into the scrotum called orhiopeksiey. Operation is simple. First opened inguinal canal, and there is extracted an egg through an incision in the scrotum is placed into it. Then, the egg is fixed to the scrotum seams.

When abdominal cryptorchidism surgery is performed in 2 stages with an interval of 6-12 months. After surgery, the child is in the hospital for 1-2 days, the stitches are removed on the 10th day.

During the first month the doctor observes the patient every week, then once a month (first six months), followed by 2 times a year.

Possible postoperative complications include damage to the spermatic cord, the development of hydrocele, disease recurrence, bleeding and suppuration of postoperative scar.

complications

When untimely treatment of cryptorchidism, the following complications:

  • infertility (especially in the abdominal cryptorchidism - abdominal temperature higher by 1 - 2 degrees, which can lead to irreversible consequences of spermatogenesis in the testes and disturbance);
  • Testicular torsion (emergency situation, which is characterized by the appearance of sharp pain in the lower abdomen, fever, intoxication syndrome);
  • testicular cancer (occurs 10 times more frequently in patients with cryptorchidism than in healthy);
  • diseases with a combination of inguinal hernias;
  • mental disorders.

The prognosis for timely and quality treatment of cryptorchidism favorable. Most of the patients with genital function is not impaired.

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