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Cryptorchidism in children and adults: features of the course and treatment of pathology

Currently, in boys born with fetal malformations, 7% of the diseases are in the urinary system. Anomalies can be either quantitative, for example, the absence, decrease or increase in the number of testicles, or associated with a change in their normal position. Cryptorchidism belongs to the last group of diseases.

Content

Description of the disease

Cryptorchidism (unanimity) is a congenital or acquired pathology characterized by the failure of one or both testicles to descend into the scrotum.

During the development of the boy in the womb, the testes are located in his abdominal cavity. Normally, at the beginning of the eighth month, the testicle passes through the inguinal canal and descends into the scrotum. If the pregnancy was preterm, the baby can be born with a pathology caused by undescended testicles.

All premature babies are at risk - the disease is more common among them.

It is also possible that in full-term boys the testicle gets stuck along the way of omission:

  • in the abdominal cavity;
  • in the inguinal canal;
  • at the entrance to the scrotum;
  • under the skin.
Cryptorchidism scheme

Cryptorchidism is the most common anomaly of testicular development.

The main symptom of the disease is the absence of one or two testicles in an infant. Usually, pathology is found in the maternity hospital when examined by a neonatologist or surgeon. Also, the mother of the baby herself is able to recognize this anomaly in the child.

In adulthood, cryptorchidism can be detected due to the lack of early diagnosis, as well as a consequence of injury. In this case, the surgical method is the only way out, since the incorrect placement of the testicles increases the probability of oncology and infertility.

When diagnosing a disease, you should not postpone the visit to the surgeon, andrologist and urologist. This will allow prompt treatment and avoid complications.

Video: children's urologist-andrologist KS Abramov about cryptorchism

Congenital, acquired, right-sided, left-sided, bilateral, inguinal, abdominal, false and other forms of cryptorchism

Establishing the type of cryptorchidism is important in determining therapies and age appropriate for the surgical procedure.

Cryptorchidism classification

To clarify the upcoming volume of interventions, the classification of cryptorchidism is of great importance.

Retention and pseudoretension

True cryptorchidism (retention) is considered undescended one or both testicles. In this variant of the disease, the scrotal underdevelopment is always observed.

It is impossible to lower the testicle into the scrotum due to the location of the gland in the abdominal cavity, behind the peritoneum or in the inguinal canal.

Also, with manual examination, it is not always possible to determine the correct location of the testicle.

congenital bilateral cryptorchidism

True bilateral cryptorchidism - a common pathology in premature babies

In case of false cryptorchidism (pseudoretension) the testicle is mobile, it can be in the inguinal canal and descend back into the scrotum.

With pseudoretension, the testicle can easily be returned to its place by palpation.

The reason for pseudoretension is the small size of the testicle in comparison with the inguinal canal and the tone of the ligaments that hold them. False cryptorchidism manifests itself in sports, hypothermia and in stressful situations. The anomaly usually disappears with age, so it does not require additional treatment.

According to localization, that is, depending on which part of the scrotum testicular prolapse did not occur, they are distinguished:

  • right-sided form of cryptorchidism;
  • left side.

The first variant occurs most often in half of the patients, the second in 35–40%, the remaining 10–15% falls on bilateral cryptorchidism.

Extremely rarely (1-3% of cases) diagnostic methods determine the absence of one testicle (congenital monochrism) or both testicles (anorchism).

<br /> Right-handed cryptorchism

Right-sided cryptorchidism occurs in half the patients

In addition to the above forms, allocate acquired cryptorchidism. This is a non-congenital disease, which is a consequence of an injury to the inguinal region, or the result of a hernia repair and wearing a bandage during the rehabilitation period. There is also a variant of the development of anomalies in boys under the age of 10 years due to the fact that the growth of the spermatic cord does not keep up with the formation of the body of the child as a whole, it is shortened and the testicles rise back to the groin area.

Ectopia

In addition to retention, the patient can be diagnosed with an ectopic condition.

Types of ectopia

Ectopia - displacement of the testicle from the scrotum to an abnormal position

Ectopia is the displacement of the testicle from the scrotum to the abnormal position:

  • in the inguinal canal;
  • under the skin in the groin area;
  • in the crotch area;
  • at the root of the penis;
  • in the opposite part of the scrotum (a rare form - cross ectopia);
  • on the inside of the thigh;
  • in the abdominal cavity.
Inguinal cryptorchidism

When inguinal cryptorchidism testicle palpable in the inguinal canal

Unlike retention, ectopia always develops in utero and is characterized by normal descent of the testicle through the external inguinal ring, only after a while there is a deviation from the path to the scrotum and moving to an abnormal location.

Causes and factors of the disease

Disruption of the normal process of prolapse of the testicles gives rise to the development of cryptorchidism. The main causes of the disease are:

  1. The specificity of anatomy, characterized by the presence of mechanical obstacles to the progress of the testicles into the scrotum:
    • narrowing of the inguinal canal;
    • short seminal process;
    • poor nutrition of the testicle (as a result of vascular deformity), etc.
  2. Dysfunction of the endocrine glands: a decrease in the number of male hormones produced in the child’s body still in the womb, as well as a lack of gonadotropic hormones in a pregnant woman.
  3. Chromosomal abnormalities due to the influence of external adverse factors:
    • transfer of viral disease to a pregnant woman (flu, rubella);
    • harmful working conditions for the mother (the influence of chemicals, toxins, pesticides, radiation);
    • bad habits of a pregnant woman (drug taking, smoking, alcoholism);
    • bad ecology.
  4. Admission of non-recommended drugs by the mother during gestation:
    • painkillers (Analgin, Paracetamol, Ibuprofen);
    • hormonal (dexamethasone).
  5. Heredity.
  6. Multiple pregnancy.
  7. Premature birth - low birth weight babies are especially prone to cryptorchidism.

Hormonal and painkillers, the use of which provokes the development of pathology, in the photo

Symptoms in adult men and newborn boys

An obvious symptom of the disease in newborns is an asymmetric scrotum with unilateral cryptorchidism, as well as the absence of a testicle in it at palpation. With bilateral retention, the scrotum is empty and compressed.

As a rule, abnormally located testicles can be palpated manually through the abdominal wall or through the skin, sometimes it is impossible to determine their position.

In addition, cryptorchidism in adults manifests pain in the groin and abdomen. Pain often increases with:

  • playing sports;
  • constipation;
  • sexual arousal.

Men may discolor semen.

Diagnostics and differential diagnostics

Diagnosis involves taking anamnesis and conducting a survey. In analyzing the course of pregnancy of the mother, the presence of factors provoking the formation of cryptorchidism is considered.

Important! Anomaly is difficult to determine according to laboratory tests, so this diagnostic method is not sufficient. Only with the development of pathological processes can you see indicators that indicate inflammation.

Diagnosis is carried out by probing. If the testicles could not be palpated in the inguinal canal, examine the hips and perineum to identify it.

Cryptorchidism diagnosis

Detection of cryptorchidism using ultrasound

In case the probing failed to detect the missing testicle, other tests are carried out:

  • contrast vazografiya - carried out through the introduction of contrast into a vein. After that, an x-ray is taken, which shows the vessels leading to the abnormally located testicle. In the absence of blood vessels, monorchism is diagnosed;
  • CT - gives an idea of ​​the three-dimensional image of the organs;
  • Doppler ultrasound is performed to detect blood flow disturbances in the vessels and their patency, as well as to eliminate the congenital absence of the testicle and, as a result, to eliminate the need for surgical intervention.

In the diagnosis of the disease, consultations of specialists are necessary: ​​a surgeon, andrologist, urologist.

Differential diagnostics

Examination of the baby is carried out by palpation.

An important condition: the diagnosis should be carried out in a warm room.

If the testicle is not detectable in the scrotum, the inguinal canal is probed, and when the testicle is located there, its consistency and the presence of pain are assessed. During palpation, they try to return the testicle to the correct position: if it is possible, the disease is classified as pseudoretitia. This procedure is the basis for deciding in favor of true or false cryptorchidism.

Treatment of undescended testicles: techniques, age at which to begin therapy, and other nuances

There are two ways to treat cryptorchidism: operational and conservative.

Rapid correction of cryptorchidism and rehabilitation after intervention

Applicable after the first two years of a child's life. It is believed that after this time, an independent solution to the problem is no longer possible. The course of the operation depends on the state of the testicle and the presence of degenerative modifications in it. In the case when the testicle has undergone serious morphological changes, resorted to removal of the organ.

The chances of finding a healthy organ or its excision are equal.

If the organ has not lost its functions, then orchippexy is performed - an operation during which the testicle is lowered and fixed to the skin of the thigh through the scrotum.

Orchipexia

Orchipexia (also referred to as orchiopexy and orchidopexy) is a surgical operation used in cryptorchidism, the purpose of which is to attach the testicle to adjacent tissues with sutures

After 9–12 months after surgery, the scrotum is surgically separated from the thigh.

Patient after orchidopexy

Patient after two-stage orchidpexy

There is also a one-step version of the operation:
  1. By dissecting the soft tissue open access to the inguinal canal.
  2. Inject the testicle into the scrotum.
  3. Make the plastic walls of the inguinal canal.
  4. Stitched.

After surgery, orchidpexy is allowed to get up on the third day, and seams are removed on 10–12. After four weeks of eliminating physical exertion, including strength exercises, the patient returns to his usual lifestyle.

When implementing an intervention in adolescence, it is extremely important to pay attention to the psychological aspects. It was recommended to observe young men from psychologists and to conduct psychotherapy sessions in order to exclude the emergence of complexes and feelings of inferiority.

To exclude psychological problems, experts recommend performing such operations at a younger age.

Contraindications to surgical intervention are:

  1. Disturbance of blood clotting.
  2. Severe systemic diseases.

Reviews of parents and patients undergoing orchidopia

At this time I am lying with my son in the hospital, we had an operation, everything went fine, the operation went quickly, we are getting better. Son 2.5 years.

Novel

http://www.tiensmed.ru/news/post_new9950.html#comments

We had a surgery when the grandson was a year and seven months old. The operation went well. We have been looking for a good doctor for a long time so that we can do it as it should be. The child, too, after surgery quickly went on the mend. So do not be afraid. And it’s much worse if you don’t do the surgery while it’s small. They even development can be disturbed by the lack of these hormones. And they are not produced if the iron is not working. Therefore, it is necessary to do everything in time and not be afraid of operations. This operation is not so scary.

Zinaida

http://www.tiensmed.ru/news/post_new9950.html#comments

I can say on my own that in time a not done operation already threatens simply with the fact that the testicle will be taken away. That's what happened to me. And not just removed it, but due to the fact that there was a threat of pinching. And it is very dangerous and can be life threatening. After all, pinching is not a joke. This testicle can die off inside, and then there will be serious problems for the whole organism. So I deleted it. The second, however, working and normal. But my wife and I were five years old children were not. Apparently, one does not work as well as two.

Andrei

http://www.tiensmed.ru/news/post_new9951.html#comments

We have had this problem since 1 month. All the time they were observed by a surgeon, and at 7 months they had to have an operation, since there was a pinching of the testicle. But everything went very well, in the evening we were already at home (but I asked the doctor for it), however, it was hard to leave the anesthesia. But now even the scar is not visible.

mama ja

http://www.komarovskiy.net/forum/viewtopic.php?t=2313

I'll tell you, suddenly someone will come in handy. We also had left-sided cryptorchidism. The surgeon from the children's clinic sent to Filatovskaya. The first consultation was in Maskins for 5 months - they said not to rock the boat until the year. A year seemed again, prescribed injections of gonadotropin. The necessity was substantiated by the fact that the blood supply will be improved and the testicle will be more mobile, which is important for the operation. The operation was done in the inpatient hospital of one day, in the same place, in Filatovskaya. We arrived at 8 am, in the second hour we went home. The whole operation lasted 35 minutes. Naturally, they did not allow my mother into the operating room, she was shaking in the corridor. They were very afraid of anesthesia - the baby was only 1.4, and general anesthesia. He came out hard - it twisted him terribly, barely restrained him. When more or less waking up, asked for a boob. The anaesthesiologist did not approve, but Maska was unstoppable, besides, he was hungry and he fed up, poor fellow. Contrary to fears, we didn't have vomiting. About 20 minutes after waking up, they tried to ride 🙂 The doctor is good, professional. Shovchik is cosmetic, about 2 cm. The doctor ordered Nurofen to necessarily be anesthetized in the evening on the day of the operation and for the night, and then on as. The next day Nurofen did not give. The kid was very cheerful. The only inconvenience - you can not wash for a week - you cannot wet the seam. Well, take care of injuries, shocks in a delicate place. Edema and swelling slept for weeks and a half. Now the child is cheerful, cheerful, and mom has one less headache 🙂 Good luck

Katerinych

http://www.komarovskiy.net/forum/viewtopic.php?f=48&t=2313&start=30

Video: cryptorchidism in children - treatment by surgery

Conservative treatment

Correction of the disease with hormonal drugs is possible at the age of up to a year and is recommended only in the form of false cryptorchidism. Treatment is carried out by chorionic gonadotropin from the six-month-old baby, when spontaneous descent of the testicle is still possible. Also, hormonal therapy is resorted to in preparing the patient for surgery.

Human chorionic gonadotropin

Treatment of cryptorchidism should begin with chorionic gonadotropin, and the greatest effect is achieved in children with bilateral and inguinal retention

In the treatment of patients in the pubertal period, along with the introduction of chorionic gonadotropin, hormone therapy with methyl testosterone is given. With this therapy, there is no inhibitory effect on the development of the testicles.

Many experts have a very negative attitude towards hormone therapy in young boys, because it affects the delay in the development and maturation of the testicles. In the United States, such treatment of cryptorchidism is not carried out due to lack of evidence of effectiveness.

In the absence of positive dynamics after conservative treatment, orchippexy is also performed.

Exercise therapy: what exercises can be performed

During conservative treatment, the patient is recommended to do special exercises that contribute to the descent of the testicles to the correct position:

  • gymnastics for the pelvic muscles;
  • gymnastics for the abdominals;
  • movements of the feet on the floor, performed similar to rubbing floors;
  • swimming;
  • bicycle riding.

Folk remedies

Treatment of cryptorchidism with folk remedies is contraindicated, as it not only does not bring the desired effect, but can also harm a healthy organ. The best option would be to contact a specialist and get expert advice.

Treatment prognosis and possible complications: testicular cancer, infertility and other dangerous consequences

Often parents prefer hormone therapy instead of surgery. The effectiveness of this treatment is low (about 30%). With timely surgical intervention (up to 1.5–2 years), the prognosis is positive. Currently, postoperative complications are rare, but the likelihood of their development does exist. So, the consequence could be:

  • the development of bleeding, edema;
  • incorrect location of the testicle in the scrotum;
  • testicular atrophy;
  • damage to the sperm outlet;
  • the development of inflammation in the testes or appendages;
  • infection sutures.

In the absence of proper treatment of cryptorchidism, the following effects can develop:

  • pain due to incorrect anatomical location of the testicle;
  • inguinal hernia;
  • pinching, torsion testicles hydatides;
    Torsion of testicle

    Torsion of the testicle is a very dangerous situation, in which, in a short time, blood flow is disturbed, accompanied by severe pain, and the organ dies out within a few hours.

  • oncology (testicular cancer). The development of malignant tumors in cryptorchidism is determined by the location of the testicle in an environment whose temperature is more than necessary for the gland to fully function. This provokes a mutation of tissues and leads to serious changes;
  • infertility.
    Infertility with cryptorchidism

    When the testicle is in the groin or in the abdominal cavity, too high a temperature is created that prevents the formation of healthy sperm

Prevention of pathology

A healthy lifestyle of a pregnant woman is the prevention of possible abnormalities in the fetus, including cryptorchidism. When carrying a baby, the expectant mother must observe the following rules:

  1. Refusal of bad habits (alcohol, smoking, drugs).
  2. Avoid contact with viral patients, if possible - prior vaccination against influenza, rubella.
  3. Reception of pharmaceutical preparations only under the supervision of a physician.
  4. When working in hazardous production - change of type of activity, the transition to easy work.
  5. Planning of pregnancy, preliminary assessment of hormonal background and treatment of the revealed violations before conception.
  6. Avoiding stressful situations.
  7. Maintain a healthy lifestyle (proper nutrition, normal physical activity) before and during pregnancy.

Video: E.O. webinar Komarovsky on the lifestyle of a pregnant woman and its impact on the health of the fetus

When making a diagnosis of “cryptorchidism”, one should not despair, one should follow the recommendations of the attending physician and should not be afraid of prescription of the operation, since the risks of complications after surgery are much less than the threat of consequences if the therapy is not conducted.

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