Cryptorchidism is the absence of one or both testicles in the scrotum. They can be located either in the abdominal cavity or in the inguinal canal, as well as under the skin in the groin or thigh, in the pubic area, perineum. The right-sided variant of the pathology is more common. This is due to the anatomical features of the structure of the male body. Left-sided cryptorchidism is quite rare even inside its pathology, as a rule, in babies with a mirror arrangement of organs. Usually mothers, when they find out the diagnosis, fall into a certain lengthy state and think that this is the end of their child’s life. But modern medicine has a lot to offer these children.
Statistical data
This pathology is quite common both in premature and full-term babies. But during the first six months of life, an independent prolapse of the testicle usually occurs, and the question of surgical intervention is removed. In addition, the disease can be diagnosed in boys aged one year or more. Somewhere in three percent of cases, an undescended testicle is not palpable. This means that it did not form in the process of fetal development. This condition is called monorchism or anorchism, depending on whether the second testicle is preserved.
Ontogenesis of internal genital organs in men
The laying of the buds of future testicles occurs at the sixth week of the fetal life. The genital cord forms the cortical and medulla, which subsequently become the albumen and mesenchyme of the penis.
Three weeks later, the cellular composition of the genital cords is differentiated (these are processes from the cortical layer that pass through the testicular substance) - Sertoli cells are formed . And from the mesenchyme cells Leydig cells are formed. They begin to secrete hormones that help in the further development of the fetus.
Initially, the testicle is located in the abdominal cavity at the level of the kidneys, but in the process of intrauterine development, it moves to its permanent anatomical position. It goes its way, starting from the twentieth week of pregnancy and up to the fortieth. Moving forward, the testicle carries along the peritoneum, muscle fascia and, thus, forms the inguinal canal.
Etiology of Cryptorchidism
Cryptorchidism (ICD-10 refers it to the section of the consequences of chromosomal pathologies) can occur for a number of reasons. From the outside it seems that they are in no way connected with hereditary material and have a very distant relation to the genitals, but the human body is structured in such a way that everything in it has an outlandish causal connection.
First of all, the disease can be caused by diseases suffered by a woman during pregnancy. It can be flu, rubella, toxoplasmosis, sexually transmitted diseases.
Secondly, cryptorchidism is one of the signs of intrauterine growth retardation. It can be combined with other anomalies, such as hypertelorism, cleft lip, cleft palate, curvature of the spine, irregular shape of the skull.
Thirdly, there may be an anatomical obstruction that prevents the testicle from descending.
Fourth, if the mother took non-steroidal anti-inflammatory drugs during pregnancy, then this is sixteen times more likely to give birth to a baby with a pathology.
Types of the pathological process
Cryptorchidism in men is of several types, depending on the location of the undescended testicle and its presence in principle.
- True. Its characteristic feature is that the surgeon is unable to manually lower the testicle into the scrotum. The location of the latter can be different: in the abdominal cavity, in the inguinal canal, in the upper part of the scrotum, and so on.
- False. The main difference is the ability to still lower the testicle manually, regardless of its location. The cause of this condition may be the excessive tone of the muscle that lifts the testicle, although normally it is reduced by two years of a child's life.
- Ectopia. It is associated with the atypical location of the testicles. The sex gland can be located under the skin of the thigh, perineum, at the root of the penis or in the inguinal region (the so-called inguinal cryptorchidism). The difficulty is that omitting it will not work.
- A tightened testicle. Such a phenomenon is possible in cases when an already descending sexual gland rises again due to the shortening of the underdeveloped spermatic cord.
It is logical to assume that testicular cryptorchidism is manifested by the absence of one or both testicles in the scrotum. This fact is determined by the pediatrician together with the urologist with the help of a visual examination and palpation of the inguinal region of the child. The scrotum in this case looks flat, "empty", underdeveloped.
Symptoms
Usually, a pain symptom does not occur, but in the pubertal period, pulling discomfort in the abdomen or on the corresponding side in the iliac and inguinal areas is possible. They increase with sexual arousal, straining, constipation, excessive stress.
Diagnostics
Cryptorchidism in men is a fairly common pathology, so it is necessary to examine the baby for the presence of this disease in the first days after birth. According to the norms, the child is placed on a warm diaper in a room where the temperature is not lower than twenty-two degrees, and after sterile processing of the hands, palpation begins.
The fingers of the left hand are located on the base of the scrotum to prevent further displacement of the testicle, and the other probes its location. After making sure that there is no genitals in place, they rise higher to the inguinal canal and check there. If you can lower the testicle manually, then the problem can be considered resolved.
Instrumentally, the absence of the testicle can be confirmed by conducting an ultrasound scan of the inguinal region, including the scrotum. In addition, you can use visualization methods such as radiography, MRI, or CT with a contrast agent. If the case is extremely complicated, diagnostic laparoscopy is recommended . To make sure that this case refers to monorhism or anorhism.
In addition, a laboratory blood test for hormones and genetic mapping can exclude such a rare pathology as male pseudohermaphroditism. It is characterized by the presence of external male genital organs and the absence of internal ones.
Complications
Before describing what can result in untreated cryptorchidism in the future, let us dwell on one very important issue. For the normal functioning of the testicle, a slightly lower temperature is needed than what is considered normal for the body. That is why nature is conceived in such a way that the scrotum is, as it were, “taken out” - so its “contents” do not overheat. This in the future affects the quality of the reproductive function of men. For the same reason, boys and then men are not recommended, for example, to take too hot baths.
Well, now, in fact, about the complications.
- Testicular cancer. Since this pathology occurs when the chromosome apparatus is malfunctioning, even surgical removal of the testicle into the scrotum does not guarantee that the oncological process will not develop in the distant future.
- Decreased hormonal function. It manifests itself in delayed puberty, the inharmonious development of secondary sexual characteristics: body hair is of the female type, there are no mustaches and beards, the voice remains high. In the future, impotence awaits these boys.
- Hernias. Most often with undescended testicles, an umbilical or inguinal hernia develops. Visually, it may not be determined, but if infringement occurs, the man will need urgent hospitalization and surgical treatment
- Reproductive dysfunction. Due to difficulties with spermatogenesis (high temperature in the abdominal cavity does not contribute to sperm maturation), as well as hormonal complications, the quality of the ejaculate is reduced.
- Testicular torsion is a morphological abnormality of the spermatic cord. Because of this, the excretion of seminal fluid from the testicles to the penis is disrupted.
- Injuries. Improper positioning increases the likelihood that a sensitive organ will be injured. This can happen even with careless actions of a doctor.
Here cryptorchidism can lead to such results. The consequences themselves can terrify any sane man, let alone a young mother with a little boy in her arms.
Surgery
If manual reduction of the testicle during examination is not possible, then usually doctors recommend resorting to an operative method of treatment before the child is one year old. This method is very effective, with its help it is possible to say goodbye to such a pathology as cryptorchidism. The operation is called orchipexy and consists in the fact that the surgeon carefully selects the testicle along with the membranes and moves it inside the scrotum. It can be performed laparoscopically or by open method. The boy must be examined before surgery to exclude other diseases and prevent possible complications. If during the intervention the surgeon noticed necrotic tissue or the formation of an inguinal hernia, then he will remove it at the same time, along with the reduction.
After surgery, it is important to observe the patient both before and after discharge. The doctor must be sure that the testicle has taken root and is functioning normally. Cryptorchidism is not a sentence for a child, you only need to correctly describe the possibilities of modern surgery to the mother.
Hormone therapy and other methods
Hormones are a slightly less effective remedy, but nevertheless it sometimes helps to cure cryptorchidism. Treatment consists of a course of injection of chorionic gonadotropin. Such an intense attack on the body leads to a displacement of the testicle in a normal position. But the method does not give a 100% guarantee, therefore it is rarely used.
With monorchism or anorchism, it may be suggested to install a testicular prosthesis. In childhood, this is not necessary, but in the puberty period, the boy may develop complexes due to his otherness. And cosmetic surgery can offer various options for plastic surgery.
It is also recommended that you consult with an endocrinologist about puberty and hormone therapy at this time. Since sometimes without drug support, the body is not able to produce enough endogenous hormones to establish a fertile period of life.
Forecast for life and health
Orchipexy, as the most common correction method, completely eliminates cryptorchidism. Infertility is observed in less than one percent of men. But fertility will be slightly reduced if two testicles do not fall, and not one.
As for complications, such as cancer or trauma, it is difficult to say for sure whether the operation removes the threat to the end. In any case, it prolongs life and improves its quality.
Recommendations
After surgery, it is important to regularly engage in diagnostics. It is not necessary to do this in the hospital, a home examination is quite suitable. It will be more convenient to do this in the process of bathing the baby or changing the diaper. When the child grows up, it will be necessary to conduct a conversation with him about his health and explain how important a regular examination and self-examination is.
Cosmetic solution
A teenager may be worried about being different from others. Mom should be ready for this too. In this case, one conversation will not be enough. It will be necessary for the child to purchase free underwear, sportswear, bathing accessories so that his defect does not catch the eye. You can begin to probe the soil regarding prosthetics. But if a teenager does not feel such a need - do not insist. Still, this is a rather expensive and traumatic operation.
Prevention
There is no specific prophylaxis per se. Cryptorchidism is not a disease that can be anticipated and appropriate measures taken. The only thing that can be done is to properly and seriously prepare for pregnancy: do all vaccinations, sanitize the oral cavity, eliminate all foci of infection. In the first trimester, you should not deal with toxic substances, carry out repairs in the apartment, carry heavy loads. Before taking medicines, you should definitely consult your gynecologist.
Mother and child should remember that cryptorchidism is not a life sentence; everything can be corrected. The main thing is not to miss the moment when correction is possible, and to approach this issue responsibly. Do not be afraid to contact your doctor with questions, clarify the tactics of treatment and replacement therapy. He will gladly answer them. For this in the future, your son will thank you very much.