Signs of bilateral cryptorchidism. How does right-sided cryptorchidism occur? Symptoms of bilateral cryptorchidism and possible complications

Cryptorchidism is a male disorder characterized by failure of one or both testicles in the scrotum. As a rule, boys get sick in infancy.

The most common form of cryptorchidism is congenital

Description of the disease

Statistics say that half of premature male babies have right-sided cryptorchidism at birth, 30% of newborns are diagnosed with left-sided cryptorchidism, and 20% have a bilateral form. Doctors establish that in 90% of children in the first year of life the disease disappears on its own, and for 10% of children medical assistance is required. The higher the underdeveloped testicle is from the scrotum, the greater the likelihood of complications.

Causes of cryptorchidism

In medicine, the exact causes of cryptorchidism have not been established. However, experts say that the following factors can cause cryptorchidism in children:

The main alleged causes provoking the development of the disease: disorders in the endocrine system, genetic failure in the formation of the fetus in the womb and anatomical obstruction.

Cryptorchidism develops with a sharp decrease in testosterone levels

Types of disease

There are several types of cryptorchidism, but the treatment of each form of the disease comes down to one thing - surgical intervention.

According to the location of the testicle, there are:

• Abdominal cryptorchidism. It is observed when the testicle is not descended from the abdominal region.
• Inguinal cryptorchidism. It is characterized by the fact that the testicle, after leaving the abdominal region, went into the inguinal zone and remained there.

Depending on the location of the testis, inguinal and abdominal cryptorchidism are distinguished.

According to the degree of displacement of the glands, they are distinguished:

• False cryptorchidism. It is characterized by the movement of one of the testicles from the scrotum. Factors affecting movement are muscle tension and cold. With this form, the scrotum is symmetrical in a balanced state and develops within the normal range. When pressed, an omission is felt in the scrotum due to the warmth of the hands, and with tension in the muscles of the inguinal zone, the iron is able to migrate into the fold of the groin.
  False cryptorchidism is just a feature of the boy's physiology and its consequences are not so terrible. It may go away on its own and treatment is not needed until after adolescence.
• True cryptorchidism is characterized by the impossibility of manually returning the gland to the seminal pocket, as in a false form. Basically, the sex gland is located in the groin ring, less often in its canal. With this form, both testicles and one can be delayed. True cryptorchidism is often accompanied by a hernia in the groin of men, the treatment of which is possible only by surgery. The consequences of true cryptorchidism threatens the infertility of a man.
  Often this type of disease is confused with testicular ectopia, in which the gland does not fall into the scrotum, but into the perineum.

True cryptorchidism is often accompanied by the appearance of an inguinal hernia.

The first type of disease occurs in half of the registered cases.

According to the time of the formation of the disease, there are:

• Congenital cryptorchidism. This form is observed at birth, when the gland did not descend during pregnancy. Often seen in premature babies.
• Acquired cryptorchidism. The form of the disease is recorded after birth. It affects boys aged 1 to 10 years.

On the side of the development of pathology, a unilateral and bilateral type of cryptorchidism is distinguished:

• Left-sided - the absence of a testicle on the left side.
• Right-sided - the absence of a testicle on the right side of the scrotum.

The acquired form of cryptorchidism is usually detected in boys under the age of 10 years.

A boy in infancy is haunted by the following signs of the disease:

• Sharp pain in the region of undescended glands. The cutting is replaced by aching, pulling pain.
• The manifestation of pain when coughing, pressing, straining the body.
• Asymmetric flat scrotum.
• The impossibility of finding the testicle when probing.

At the age of 5 to 10 years, the boy complains of:

• Heaviness in the lower third of the abdomen and groin.

The disease causes pain in the lower abdomen and problems with urination

• Problems with urination and constipation. Pain during bowel movements.
• Increase in body temperature.

In adult men, a decrease in sperm production and quantity is added to the listed symptoms. Fixed pain during erection of the penis.

Diagnosis of the disease

The diagnosis of "cryptorchidism" is made after a visual examination and palpation of the scrotum. Any underdevelopment and flatness of the scrotum indicates pathology. If during the process of palpation it is possible to return the gland to its usual position, a diagnosis of "false cryptorchidism" is made. And if, after palpation, it cannot be “put in place”, then “true cryptorchidism” is diagnosed.

The diagnosis of cryptorchidism can be confirmed with an abdominal x-ray.

It is possible to confirm or refute the alleged diagnosis only after an ultrasound and x-ray of the abdominal cavity. The pictures will show how far it is from the inguinal rings and at what level it is located.

If, after the diagnosis, the pathology is in doubt, then they resort to MRI and CT diagnostics. Tomography is used when the testicle is located in the abdominal region. After diagnosis, the size of the underdeveloped gland becomes known. In congenital absence of the gland, the laparoscopy method is used.

In cases where children have a bilateral form of cryptorchidism, it is necessary to pass tests:

• Blood to determine the level of hCG. If the level exceeds the norm, then this indicates the development of a tumor.

A blood test is a mandatory study for bilateral cryptorchidism

• Blood for analysis of hormone deficiency.
• Blood for the study of a set of chromosomes.

Treatment of cryptorchidism

If at least six months have passed (and if the baby is premature for about a year) and the child has not descended the testicle, immediate treatment should be started. The boy is registered with a pediatric urologist, who individually selects the treatment:

• Conservative treatment. Drug treatment includes taking a special group of hormonal drugs that will help in the growth of the sex gland. For a month, the child is injected intramuscularly with the hormone choriogonin. With successful treatment, under its own weight, the testicle itself descends into the scrotum. An underdeveloped gland will gradually begin to function normally. The course of treatment is repeated after 3-4 months.
  Efficiency after medical procedures is high if the testicle is close to the scrotum. Unfortunately, with this method of treatment, the probability of the return of pathology in children is high (about 25%).
  With an abdominal location, hormone therapy is useless.

Conservative treatment of cryptorchidism involves intramuscular injections of choriogonin

• Surgical intervention. If attempts at drug treatment are unsuccessful, then in order to cure cryptorchidism, surgery is necessary. Before the operation, it is necessary to conduct a biopsy to exclude the consequences of oncology. The whole process takes place under general anesthesia. Surgical correction of pathology occurs as follows:
  • an incision is made in the groin area;
  • the sex gland is manually lowered into the seminal sac of the scrotum;
  • an incision is made in the scrotum;
  • iron is sewn to the walls of the testis.

With an abdominal location, the laparoscopy method is used, when the testicle is lowered down through a puncture in the abdomen with a special instrument. If the gonad is underdeveloped, it is removed to eliminate the risk of developing oncology.

If medical therapy fails, cryptorchidism is treated surgically.

The chances of curing the disease are high. The main thing is to start treatment on time.

Disease prevention

Preventive measures should be carried out even during pregnancy in the 2nd and 3rd trimester, because the disease is more common in congenital forms. The development of an anomaly is influenced by any negative factors, be it stress or a cold.

A woman who has close male relatives who have undergone a pathology needs to be especially careful. Therefore, you need to carefully plan pregnancy and be treated in advance for viral infections and chronic relapses.

To prevent cryptorchidism in a newborn, a pregnant woman should avoid stress and be careful

After conception, it is necessary to exclude staying near any chemical reagents, do not use medicines without consulting a doctor. For example, studies have found that the use of paracetamol contributes to the risk of cryptorchidism.

Complications of the disease

The causes of the incorrect position of the testicle carry the following complications:

• difficulty in obtaining blood supply to the testicle outside the scrotum;
• disorder of heat exchange in the inguinal region;
• diseases of the genitourinary system;

Cryptorchidism causes the development of various diseases of the genitourinary system

• endocrine diseases, including a mismatch in the number of hormones in the body;
• increased risk of injury to the testicle location area.

If proper treatment is not carried out, then the consequences of cryptorchidism are very sad:

• testicular necrosis;
• hernia in the groin;
• malignant testicular tumor;

Untimely treatment of cryptorchidism may result in infertility

• infertility;
• impotence;
• disorders of sperm production as a result of spermatogenesis.

In addition, a boy with a similar disease develops on a feminine basis: his beard does not grow, his voice is soft, his body structure resembles that of a woman, etc.

How cryptorchidism is treated and why it is necessary to seek help in a timely manner - the answers contain a video:

Cryptorchidism is a pathological condition in which one or both testicles are located outside the scrotum (in the inguinal canal, abdominal cavity, under the skin).

The testicles are paired male gonads that produce sperm and male sex hormones. They are located in the scrotum, which is necessary for the maturation of spermatozoa, the condition of which is a lower temperature than in the abdominal cavity. Normally, they differ somewhat in size and are located at different levels (usually the right one is higher than the left), they easily move in the scrotum and can completely or partially go under the wall of the peritoneum. The testicles descend into the scrotum from the retroperitoneal space from the 6th month of intrauterine development until delivery. Sometimes this happens during the first year of life.

Infertility develops in 70-80% of patients with bilateral cryptorchidism and in 20% of patients with a unilateral form of the disease.

Cryptorchidism is a common pathology, registered in 3% of cases in full-term male children and in 30% of cases in premature babies, while in children of the second year of life, the testicles descend spontaneously into the scrotum in 75 and 90% of cases, respectively. Right-sided cryptorchidism is most often observed, bilateral accounts for 10-30% of all cases.

Causes and risk factors

The mechanism of development of cryptorchidism is not fully understood. The main causes of pathology are divided into two groups:

• mechanical obstacles to the progress of the testicle: shortening of the testicle leash, fixation of the testicular vessels at the deep inguinal ring with embryonic strands, shortening and underdevelopment of the testicular vessels, underdevelopment of the inguinal canal, narrowness of the superficial and deep inguinal rings;
• dysfunction of the endocrine glands of the pregnant woman and the fetus: impaired function of the pituitary and thyroid gland of the fetus, impaired endocrine function of the placenta, diabetes mellitus type 1 or 2, etc.

Against the background of anatomical and mechanical factors, unilateral cryptorchidism is usually formed, hormonal factors, in turn, contribute to the development of a bilateral form of the disease.

Risk factors include:

• genetic predisposition;
• viral or bacterial infections suffered by a woman during pregnancy (especially toxoplasmosis, rubella, sexually transmitted infections, influenza);
• taking pregnant drugs from the group of non-narcotic analgesics;
• professional activities of a pregnant woman associated with toxic substances;
• bad habits in a pregnant woman;
• prematurity;
• fetal hypoxia, underweight child.

Acquired cryptorchidism can develop with injuries to the scrotum and inguinal ring. Secondary cryptorchidism develops due to slow growth of the spermatic cord, as a result of which the descended testicle is displaced from the scrotum.

The advantages of performing orchidopexy at an early age include the prevention of infertility, testicular trauma, and torsion of the spermatic cord.

False cryptorchidism occurs when the diameter of the testicle is small compared to the diameter of the outer inguinal ring, while in the case of muscle contraction (during tension, cold), the testicle is pulled up to the inguinal fold.

Forms of the disease

Cryptorchidism is classified into congenital and acquired, true and false. With true cryptorchidism, the testicle cannot be moved into the scrotum with manual reduction. With a false, regardless of the initial location of the testicle, it can be effortlessly brought back into the scrotum. False cryptorchidism accounts for about 50% of all cases of the disease.

Depending on the location of the testicle, cryptorchidism is divided into three forms:

• intra-abdominal- the testicle is localized in the abdominal cavity proximal to the internal inguinal ring, occurs in 10% of cases;
• inguinal, or inguinal- the testicle is located between the outer and inner inguinal ring in the inguinal canal;
• ectopic testis- the testicle is located outside its usual path of descent into the scrotum distal to the internal inguinal ring, most often in the inguinal region, perineum, on the thigh, at the root of the penis, is recorded in 5% of cases.

In addition, cryptorchidism can be primary and secondary (raised testicle), unilateral and bilateral.

Symptoms

Cryptorchidism is manifested by the absence of one or both testicles in the scrotum. With the development of a unilateral form of the disease, asymmetry of the scrotum is observed due to its atrophy on the side of the undescended testicle. With bilateral cryptorchidism, both halves of the scrotum are underdeveloped.

Cryptorchidism in men is manifested by dull (pulling, aching) mild pain in the lower abdomen and inguinal region, which increases with physical exertion, straining, sexual arousal and fast walking.

Indirect inguinal hernias accompany cryptorchidism in 90% of cases.

In some cases, when examining the external genital organs at the location of the testicle, a small tumor-like formation is detected, which is painful on palpation. In 60% of patients, the testicle is palpated as an inactive, painful formation. With the localization of an undescended testicle in the groin, the pubic bone can press on it, which contributes to its injury.

70% of men with bilateral cryptorchidism are infertile.

In the case of the development of false cryptorchidism at low ambient temperature or muscle tension, the testicle can rise into the inguinal canal and independently return to the scrotum, which is normally developed in such patients.

Diagnostics

The diagnosis is made on the basis of the examination, to clarify it, a number of instrumental and laboratory studies are carried out.

Examine the patient in a warm room. In the absence of a testicle in the scrotum, the inguinal canal is palpated (down and medially from the superior anterior iliac spine to the pubic tubercle), the perineum, the suprapubic region, and the femoral canal. When the testicle is located at the exit of the inguinal canal, an attempt is made to manually bring it down into the scrotum in order to differentiate true and false cryptorchidism.

Source: o-krohe.ru

For the purpose of differential diagnosis with a congenital absence of one (monorchism) or both (anorchism) testicles, an ultrasound examination is performed, if it is insufficiently informative, a computer or magnetic resonance imaging of the abdominal cavity and pelvic organs is performed.

In some cases, there may be a need for diagnostic laparoscopy, which, if a testicle is found in the abdominal cavity, is transferred to a therapeutic one: the testicle is brought down into the scrotum.

After surgery for cryptorchidism, patients are recommended to have regular examinations in order to timely diagnose possible malignant neoplasms.

In the absence of palpable testicles before surgery, it is recommended to conduct a study consisting in the introduction of chorionic gonadotropin, followed by determining the concentration of sex hormones in the blood. The absence of an increase in testosterone concentration and an increase in basal levels of luteinizing and follicle-stimulating hormones are indicative of anorchism.

Treatment

Treatment of false cryptorchidism in children is not required; in adolescence, it usually disappears on its own.

Treatment of true cryptorchidism can be conservative, surgical or combined. Its purpose is to correct the position of the testicles, which is recommended for children of the first two years of life, since otherwise an irreversible violation of spermatogenesis occurs. Until the child reaches nine months, expectant tactics are chosen, since there is a possibility of self-descent of the testicle into the scrotum.

Drug treatment of cryptorchidism is carried out mainly in the presence of endocrine disorders caused by bilateral cryptorchidism, after determining the level of hormones in the blood. Hormonal therapy consists in the use of human chorionic gonadotropin or luteinizing hormone releasing factor. With testicular ectopia, hormone therapy is ineffective, but in some cases it is used to improve the condition of tissues before surgery. The greatest effectiveness of drug therapy with hormones is observed in the inguinal form of the disease, in other cases, the effectiveness is estimated at 20-30%.

With the localization of one or both testicles in the abdominal cavity, testicular ectopia, or a combination of this disease with other developmental anomalies, surgical treatment is indicated:

• orchid funiculolysis- release of the testicle and spermatic cord from the surrounding tissues;
• orchidopexy- Bringing down the testicle into the scrotum with its subsequent fixation.

Cryptorchidism is a common pathology; it is registered in 3% of cases in full-term male children and in 30% of cases in premature ones.

A two-stage operation for cryptorchidism is performed when the testicle cannot be brought down into the scrotum even with maximum mobilization. During orchidopexy, a testicular biopsy is performed to exclude gonadal dysgenesis and a malignant process. The advantages of performing orchidopexy at an early age include the prevention of infertility, testicular trauma, and torsion of the spermatic cord; if necessary, simultaneous correction of oblique inguinal hernias, which accompany cryptorchidism in 90% of cases, can be carried out.

In the abdominal form of cryptorchidism, endoscopic reduction of the testicle is used. Patients with abdominal unilateral cryptorchidism and a short spermatic cord are shown laparoscopic orchiectomy. With a bilateral form of pathology, autotransplantation of the testicle is performed with its connection to the lower epigastric vessels.

Cryptorchidism in children is a certain deviation in the development of the genital organs, which is considered congenital. This disease occurs only in the stronger sex and consists in the fact that one or two testicles do not descend into the scrotum, but remain in the small pelvis or in the inguinal canal.

There are cases when the testicles are localized in the thigh area, in the groin, and also in the perineum. According to statistics, in most patients who sought medical help, it was the right testicle that did not descend into the scrotum.

Illness of the newborn

In premature boys, cryptorchidism can occur in one in five; in those who were born at term, the pathology is less common: there is only one case per ten newborn boys. In more than half of pathological cases, during the first year of a child's life, self-recovery and testicular descent are observed.

Factors that lead to deviations:

• the presence of physiological or pathological obstacles to the progress of the testicles;
• taking illegal drugs by the expectant mother during the period of gestation;
• disruption of the endocrinological glands;
• intrauterine infection of the fetus.

Normally, testicular descent should occur even inside the womb at 32-38 weeks of gestation.

Types of cryptorchidism

In medical practice, there are three types of this disease:

• false;
• true;
• ectopia.

With false cryptorchidism, the testicle is not palpable, but from time to time it descends into the scrotum and occupies a normal physiological position. This is due to the periodic tension of the muscles that are responsible for raising the testicle. This happens when the child has strong emotions (fear) or when the body is hypothermic. Often, false cryptorchidism occurs in children under five years of age. The deviation does not need treatment, since the lowered testicles are able to independently rise and fix in the scrotum. In such boys, at the time of puberty, the pathology disappears forever.

True cryptorchidism in children is that the place of localization of an undescended testicle may be the abdominal cavity or groin. The fact that the testicle is deployed in the groin can be determined by palpation by pressing on the skin of a certain area. When it is in the small pelvis, the palpation method will be uninformative, so it would be more reasonable to undergo an ultrasound examination.

Ectopia occurs during the period of intrauterine development of the fetus. The testicles in boys descend down, but they do not fall into the scrotum, but for various reasons they end up in the groin, thigh or in the abdominal cavity.

In practice, re-elevation of the testicle is sometimes encountered. It occurs due to various injuries or with improper development of the spermatic cords, when already lowered testicles fall into the inguinal or abdominal cavity.

There is unilateral (one testicle did not descend) or bilateral cryptorchidism (two testicles did not descend). Also, the disease can be right-sided and left-sided.

Consequences of cryptorchidism

Many mothers, having heard such a diagnosis, compare it with a sentence and prepare for the worst option. Cryptorchidism in children, surgery, reviews - that's what young parents are most worried about now! An experienced doctor should definitely reassure parents and inform them that this disease, with timely treatment, often does not carry complications, and the reproductive system of the male body will function normally. And also, the case histories in urology indicate that the testicles can rise into the scrotum on their own within a year or two.

In order for the testicles in boys to work well and produce a normal amount of sperm, they must be at an optimal temperature. It is the scrotum that creates normal thermoregulation; if the testicles are in the abdominal cavity, then the production of spermatozoa is disrupted, their function worsens, which can lead to irreversible consequences. Cryptorchidism is one of the causes of male infertility, the loss of the ability to fertilize. On the spermogram of such a patient, it can be seen that the total number of spermatozoa is small, and sometimes they are completely absent.

Male oncology

Also, due to the incorrect location of the testicles, oncology can occur. It is believed that for every third man who has a history of cryptorchidism, the consequences of this seemingly harmless disease can result in cancer. If the disease is not detected on palpation, then this only exacerbates the risks. Therefore, at the slightest suspicion, it is extremely important to identify the pathology and carry out effective treatment (up to surgery) of the child until he is twelve years old.

Testicular torsion

Refers to one of the serious complications of cryptorchidism. During torsion, the boy develops severe pain in the groin, cyanosis of the scrotum, vomiting, loss of consciousness, and hyperthermia. This condition is considered serious and requires immediate hospitalization.

disease in adulthood

A mature man can also suffer from this disease. Due to improper production of male sex hormones, an increase in the subcutaneous fat layer occurs, which can lead to a deviation in the functioning of secondary sexual characteristics and manifests itself in the following:

• sparse hairline on the pubis, in the groin;
• insufficient growth of hair on the face;
• low-pitched male voice.

In addition, running cryptorchidism in children very often leads to impotence in adulthood. Also, as a result of the disease, an inguinal and sometimes an umbilical hernia may occur (depending on the location of the testicle), which is no less a serious pathology, because at any moment there is a danger of pinching. When a hernia is incarcerated, there is always severe pain in the groin, the patient needs to be hospitalized. Due to cryptorchidism, the blood supply is disturbed, which in the future can lead to infertility.

We define the disease ourselves

In the family where the boy was born, parents should certainly make sure that the testicles have descended into the scrotum. It's easy to find out, you just need to carefully feel the scrotum and make sure that it has two testicles - one on the right side, one on the left side. In case of any suspicion, parents should consult a doctor for an examination. Thanks to ultrasound diagnostics, you can find out where the testicle is fixed and, based on this, choose an effective method of treatment.

Examinations that allow you to find out the presence of the disease:

• Ultrasound diagnosis of the pelvis and scrotum;
• Ultrasound diagnostics of the abdominal organs;
• MRI of the pelvis;
• blood test for male hormones;
• Vasography with the use of a contrast agent (a special substance is injected through the vessels, which is visualized on the apparatus).

As a rule, one ultrasound examination is often enough to make a diagnosis and determine the location of the testicle. But there are cases when it is not visible on ultrasound, so you have to connect an examination using MRI or computed tomography. These high-precision technologies will definitely find the “lost” testicle. Donating blood for hormones is not a mandatory element in the examination, the doctor prescribes an analysis only in cases where there is a suspicion that the child has a serious hormonal disorder. With some genetic diseases and anomalies of physiological development, blood donation to determine the level of hormones is mandatory.

Treatment of the disease

Many who are faced with a similar problem are sure that this is a very terrible disease - cryptorchidism in children. Treatment, in their opinion, consists only in surgical intervention. However, this is a misconception, sometimes hormone therapy is used in the treatment of the disease. It is effective mainly at an early age.

A special drug is also prescribed (for example, human chorionic gonadotropin or gonadotropin-releasing hormone) twice a week for 4-5 weeks. During the period of taking the medicine, the child sometimes has an increased growth of pubic hair, a change in its color and a slight swelling of the scrotum. However, these signs are acceptable (provided that the dosage is chosen correctly) and disappear after the drug is completely discontinued. Despite the fact that this method is painless, it has many side effects, therefore, in medicine, the surgical method of treatment is most often used.

Cryptorchidism in children, operation: reviews

If up to two years the pathology has not been corrected, then it is proposed to solve the problem surgically, which will allow the testicle to enter the scrotum. The operation for cryptorchidism is called orchiopexy. During the intervention, the doctor lowers the testicles into the scrotum and fixes them so that they do not return to their previous location. In those cases in which the testicles are located too high, the doctor performs surgery twice with a break of a year and a half.

The order of the operation

During the surgical operation, which is performed under anesthesia, one small incision is made in the groin area. However, it happens that it is difficult to get the tool to the testicle, in this case a more complex technology is used, step by step. It lies in the fact that the doctor pushes the spermatic cords, blood vessels, and only then fixes the testicle. Before moving it into the scrotum, the doctor performs an evaluation. With a clear underdevelopment of the testicle, it is removed, since it is no longer able to function.

The operation of cryptorchidism refers to surgical procedures of medium complexity, and therefore it should only be performed by a competent and experienced doctor.

On the part of the patient, as a rule, surgery is easily tolerated. Children quickly recover from anesthesia, adapt and are soon discharged home. However, after such an operation, it is recommended to visit an andrologist surgeon every six months and undergo a medical examination to prevent complications in the male genital area, especially if the testicle has been removed.

Some parents prefer to deal with this disease on their own, using alternative medicine methods. As long-term practice and case histories in urology have shown, the pathology in such cases only progresses. And it happens that the time when medical intervention could still help is lost. Self-medication with cryptorchidism is contraindicated!

Prognosis for cryptorchidism

In order to prevent irreversible consequences, it is necessary to detect the disease in a timely manner, conduct a thorough examination and prescribe effective treatment. If all medical requirements are met, then the prognosis is generally favorable. According to statistics, with unilateral treated cryptorchidism, infertility in men occurs in 15-20% of cases, and with bilateral - about 70%.

It is important for parents to identify the presence of an illness in a child, since timely diagnosis and treatment increase the chances of a speedy recovery. If you follow medical recommendations and solve the problem on time (before puberty), then the disease, most likely, will not affect reproductive function in any way.

An anomaly in the development of a child, in which one or two testicles are missing in the scrotum.

While the fetus develops in the mother's abdomen, the testicles form in the abdomen. If development is normal, they later move down into the inguinal canal. And by the day of birth or for 2-3 months after birth, the testicles descend, taking their usual state. But this process can be interrupted due to some reasons, which will be named below.

Researchers put forward the assumption that undescended testicles into the scrotum on time is associated with disturbances in the hormonal system of the body and the characteristics of the physiology of the child (underdeveloped inguinal canal or obstacles at the exit from it, short testicular vessels, etc.). In such cases, cryptorchidism is diagnosed in boys.

Types of cryptorchidism in children depending on the possibility of manual displacement of the testicle:

• true
• false
• ascended testicle

In true cryptorchidism in children, the testis cannot be manually moved into the scrotum. At false attempts to lower it succeed. This type of disease can be with hypertonicity of the muscle that is responsible for raising the testicle. With ectopia, it goes to the thigh, then the ectopia is called femoral, on the groin (inguinal ectopia) or in the perineum. It is not possible to manually move the testicle to the right place. When the testicle has risen, it shifts upward, since the growth of the spermatic cord is slowed down.

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You? You need to be very careful about your overall health. People don't pay enough attention disease symptoms and do not realize that these diseases can be life-threatening. There are many diseases that at first do not manifest themselves in our body, but in the end it turns out that, unfortunately, it is too late to treat them. Each disease has its own specific signs, characteristic external manifestations - the so-called disease symptoms. Identifying symptoms is the first step in diagnosing diseases in general. To do this, you just need to several times a year be examined by a doctor not only to prevent a terrible disease, but also to maintain a healthy spirit in the body and the body as a whole.

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Undescended testis is the most common, after inguinal hernia, surgical pathology that is detected in boys at birth.

In addition to psychological discomfort in a boy during adolescence, cryptorchidism often affects reproductive function, provoking infertility in the future. Surgery for cryptorchidism in children is performed after 6 months - 1 year, it is before this period that the testicle can migrate into the scrotum on its own.

Cryptorchidism - what is it?

Cryptorchidism is the abnormal (outside the scrotum) location of one or both testicles. With the development of the fetus, the testicles are laid in the abdominal cavity and in the second half of pregnancy begin to descend into the scrotum through the inguinal canal. This process is completed by the birth of the baby.

However, 4% of children born at due time do not have a testicle in the scrotum. An even greater percentage of pathology in premature babies is 15-30%. A cryptorchid testicle that has not completely passed the entire path of migration from the abdominal cavity to the scrotum may be located:

• at the inguinal ring - in 40% of cases;
• directly in the inguinal canal - in 20% of newborns with cryptorchidism;
• in the abdominal cavity - 10% of all cases;
• on the thigh, under the skin on the pubis, in the perineum.

In most cases, a cryptorchid testicle is detected by palpation; if it is located in the abdominal cavity, palpation may not give a result.

The most common right-sided cryptorchidism, often combined with on the same side. However, in most newborns with cryptorchidism, the process of testicular descent is completed on its own by 6 months due to high levels of sex hormones.

Persistent undescended testicle after 1 year remains only in 1% of children.

Causes of cryptorchidism in children

The following factors lead to the incompleteness of the process of descent of the testicle into the scrotum:

1. Genetic - a chromosomal disorder can occur if a pregnant woman has had an infectious disease (flu, rubella, toxoplasmosis, genital infections);
2. Endocrine - a violation of the hormonal background in a pregnant woman (diabetes mellitus, thyroid disease, pituitary pathology) and in the fetus;
3. Mechanical - there is an obstacle in the way of testicular descent: adhesive fusion with the abdominal cavity, shortening of the spermatic cord, trauma and the consequences of surgery in the groin (inguinal hernia, hydrocele) in adults.

Particular attention should be paid to pregnant women taking medications. So, Paracetamol, safe for the expectant mother, in combination with drugs of the NSAID group (Ibuprofen, Aspirin) increases the risk of developing cryptorchidism in a baby by 16 times.

Types of cryptorchidism and characteristic features

The decisive factor in determining the need for surgery is the type of cryptorchidism. Also, various options for undescended testicles suggest certain complications.

Types of cryptorchidism:

True cryptorchidism- is diagnosed in the event that an attempt to manually lower the testicle into the scrotum does not work. Often, this pathology is combined with other congenital anomalies: hypogonadism, inguinal hernia, underdevelopment of the hypothalamic-pituitary system.

False cryptorchidism- manual bringing down leads to the movement of the testicle into the scrotum. This condition is due to hypertonicity of the muscle that lifts the testicle. If in a normal state (the baby is calm, he is warm) the testicle is located in the scrotum, then when exposed to cold or crying, the testicle rises, and the scrotum decreases in size and shrinks.

Also, false non-descension occurs with a larger diameter of the inguinal canal in comparison with the size of the testicle. Even with the slightest tension of the abdominal wall and inguinal region, the testicle easily shifts to the inguinal ring and easily penetrates into the canal.

• The most pronounced cryptorchidism is observed in children 2-8 years old, by the time of puberty the disorder usually disappears.

Ectopic testis- with improper lowering, the testicle that has passed the inguinal canal is located under the skin on the thigh, in the inguinal zone, on the pubis or in the perineum. With such localization, the testicle is most susceptible to injury.

• Even after surgery, in most cases, the patient remains infertile.

Symptoms of cryptorchidism, complications in children and adults

An undescended testicle is usually diagnosed shortly after birth when examined by a surgeon. Cryptorchidism in adults requires consultation of an andrologist-urologist. The disease is characterized by the following deviations:

• The shape of the scrotum - asymmetry of the scrotum or its underdevelopment and flattening (bilateral cryptorchidism);
• Drawing pains in the groin or in the abdomen, with an intra-abdominal location of the testicle, the pain increases with straining, constipation, tension of the abdominal wall, sexual arousal during puberty (growing up).

Normal development of the testis and spermatogenesis take place only in the scrotum, the temperature of which is lower than in the abdominal cavity by 1.5-3ºС. Therefore, the longer the testicle is located outside the scrotum and the higher the temperature of the internal environment of the body surrounding it, the higher the risk of an early onset of changes in it at the morphological level.

In the absence of treatment, by the age of 3, irreversible dystrophy of testicular tissues develops.

Violation of the production of male hormones - in adolescence, androgenic hypofunction is detected. Boys develop slowly or completely absent (with bilateral cryptorchidism) secondary sexual characteristics: groin hair, facial hair.

• Typically, adolescents with cryptorchidism have a high voice, their physique is formed according to the female type, and obesity often develops.

Incorrect location of the testicle is fraught with the development of the following conditions:

• infertility - due to a decrease in the number of full-fledged spermatozoa;
• infringement of the testicle in the inguinal hernia - requires emergency surgery;
• testicular torsion - compression of the spermatic cord, consisting of blood vessels and nerves, leads to rapid testicular necrosis;
• seminoma - a testicular tumor occurs 35 times more often in patients with cryptorchidism;
• compression of the testicle by the pubic bone at its inguinal location;
• psychological discomfort, a sense of inferiority and problems in the sexual sphere.

Treatment of cryptorchidism in a child - is surgery necessary?

Cryptorchidism in children, with the exception of the development of complications, usually begins to be treated from 6 months - 1 year. Until this age, the child is regularly observed by the surgeon, since spontaneous displacement of the testicle into the scrotum is possible.

The surgeon-urologist is engaged in the elimination of cryptorchidism, often a pediatric endocrinologist is involved in the treatment process. Depending on the type of cryptorchidism and the development of complications, various treatment options are used:

hormone therapy- it is advisable only for false cryptorchidism and before the operation to eliminate bilateral cryptorchidism in children with a 46XY karyotype. Gonadotropic hormones for cryptorchidism are administered intramuscularly (chrionic gonadotropin) or nasal drops (gonadorelin).

• In 2/3 of patients, hormone therapy gives a therapeutic result. Treatment with gonadotropes is not carried out during puberty!

Orchidopexy- surgical removal of a cryptorchid testicle. An undescended testicle is exposed through an incision in the lower abdominal wall. A second small incision is made in the scrotum. The testicle is attracted to the scrotum, if necessary, plastic surgery of the muscles holding it is performed, and sutured.

• There are no consequences of such an operation for cryptorchidism performed up to 2 years.

Orchiectomy- removal of the testicle is necessary in the event of its necrosis due to torsion or pinching in the hernial sac. If the patient wishes (simultaneously with resection or during a second operation), implantation of an artificial or donor testicle is possible.

Treatment prognosis

Early treatment (up to 2 years) virtually eliminates the development of complications. Right-sided, left-sided cryptorchidism is complicated by infertility in 20% of cases. Violation of childbearing function occurs in 70% of adult men with untreated bilateral cryptorchidism.

Children with both undescended testicles require hormonal therapy before puberty to develop a male-like body.