Testicular prolapse is a normal physiological process that should occur gradually and end by eight months of a child’s life. Under the influence of a number of adverse factors, the testes may not fall into the scrotum - this ailment is called cryptorchidism. If there is insufficient growth of the testicles and cords, then testicular hypoplasia occurs. These diseases are included in the group of anomalies in the development of the male reproductive system and arise under the influence of similar etiological factors.
Etiology of the disease:
- intrauterine infection;
- poor nutrition of the mother during pregnancy and the effect of pathogenetic factors on the fetus (smoking, alcohol, drugs);
- gene and genomic abnormalities;
- incompatibility of mother and fetus;
- hormonal imbalance (primarily for gonadotropic hormones) ;
- gonadal dysginesis;
- improper development or underdevelopment of testicular ligaments.
Classification of cryptorchidism:
- True undescended testicle in the scrotum - the testicle is located in the pelvic cavity, inguinal ligament, and it cannot be lowered on its own into the scrotum.
- False cryptorchidism is muscle hypertonicity. As a rule, in such a situation, the testicle can be lowered into the scrotum without surgical intervention.
- Ectopia or abnormal location of the testicle (on the thigh, groin).
- A retracting or rising testicle is a slow growth of the spermatic cord.
Testicular hypoplasia - classification:
- One-sided - one of the testicles of normal shape and size, the function is not violated.
- Bilateral hypoplasia is regarded by urologists as an anarchism and requires a serious approach.
Disease Diagnostic Algorithm
1. General examination of the patient - in most cases, this particular technique provides the most information to the doctor. The size and symmetry of the testicles are visually assessed. It is also necessary to examine the skin in the scrotum. Often a mechanical obstruction or hernia can lead to undescended testes.
As for hypoplasia, it is necessary to determine the size of each of the testicles.
2. A survey of patients or their parents (this applies to children) should include the following questions:
- when they first noticed the violation;
- Does the patient feel pain or discomfort in the perineum at rest, during urination or defecation;
- What symptoms bother the patient
- how was the pregnancy of mom;
- which pathological factors, of the above, could have an effect on the fetus;
- whether the patient’s mental and physical development corresponds to his biological age.
3. Palpation examination of the scrotum and rectum.
4. Spermogram and determination of testicular temperature.
5. Analysis for sex hormones and thyroid hormones.
6. Ultrasound of the scrotum with vascular dopplerography. If necessary, angiography can be performed.
Testicular hypoplasia often occurs due to genetic abnormalities, so the doctor may order an analysis to examine the patient’s gene structure.
Cryptorchidism treatment
First of all, you need to resort to surgical descent of the testicle into the scrotum. The sooner this is done, the lesser the consequences for the patient. Only people with false cryptorchidism need hormone therapy ; it is performed before surgery.
Testicular hypoplasia: treatment
If the patient has one testicle reduced, and the second is functioning normally, then the doctor may suggest prosthetics for the hypoplastic testicle. This operation is carried out only for an aesthetic purpose, because scientists cannot yet create functioning organs artificially.
In the case when a bilateral decrease in the testes is diagnosed, hormone replacement therapy should be resorted to for the development of secondary sexual characteristics. Then, prosthetics of the organ can also be performed.
Testicular hypoplasia is not only a physiological disorder, but also a psychological trauma, so some patients need to consult a psychologist for help.