Under the diagnosis of cryptorchidism is implied a congenital anomaly associated with the absence in the scrotum of a newborn one or two testicles.
In another way, this pathology is called undescension of the testicles, since they are located above their anatomic bed (scrotum), in the inguinal canal, under the skin near the genitals or in the abdominal cavity. The higher they are, the more likely it is to detect abnormalities in the cellular structure of the organ and the higher the risk of complications.
The exact causes of development of cryptorchidism are not yet known and in each specific case they may differ. To the most frequent and probable carry endocrine and genetic disorders, as well as mechanical obstacles in the path of the testicles.
Among the chromosomal pathologies, Down syndrome, Noonan and 47 are isolated, as well as the mutation of the GTD gene and various defects in the formation of the anterior abdominal wall. Such violations in the genetic structure can arise spontaneously, but in about a quarter of cases they are inherited.
Another important factor in cryptorchidism is prematurity. About 20% of babies born with a body weight of less than 2 kg, testicles are not omitted, as in all boys weighing less than 910 g. The process of forming premature babies is not yet complete and continues after their birth. Approximately 2-3 months the testicles are usually omitted.
Often the cause of cryptorchidism is the hormonal imbalance in the fetus. It can be caused by:
- Inadequate production of luteinizing hormone due to disruption of the pituitary gland;
- Pathologies in the development of testicles;
- Excess estrogen in the embryo.
All these conditions affect the level of testosterone or sensitivity to the hormone, reducing them. Since it is testosterone that triggers the processes necessary for the normal omission of organs in the scrotum, such disorders cause cryptorchidism.
The formation of the testicles and their progress can be affected by diseases of the future mother - viral diseases, for example, influenza and rubella, toxoplasmosis, thyroid disease and diabetes mellitus.
Sometimes cryptorchidism provokes mechanical factors, for example, narrowing of the inguinal canal and the presence of fibrous septa, shortening of blood vessels and spermatic cord, underdevelopment of ligaments and non-spreading of the vaginal process. Such features of the body are often inherited and prevent the testicle from advancing to the right place.
In the past few years, the autoimmune theory of cryptorchid development has been actively studied. Immunity can attack the sex glands, counting them as bacteria, and lower the sensitivity of the testicles to testosterone.
Modern physicians distinguish several types of cryptorchidism:
- True cryptorchidism. The testicle is not dipped into the scrotum with the help of manual reduction. It can be in the inguinal canal in the upper or middle part of the scrotum or even in the abdominal cavity.
- False cryptorchidism. The testicle can be dropped into the scrotum at any of its original positions. The reason for such a pathology in increasing muscle tone.
- Ectopia of testis. The organ is found on the thigh, in the perineum, in the groin or at the root of the penis. You can not bring him into the scrotum with your hands.
- The testicle that rose. Sometimes the organ descends into the scrotum, and then rises back because of too slow growth of the spermatic cord.
Examination на предмет крипторхизма необходимо проводить в первые дни или недели жизни малыша. Делают это при помощи пальпации мошонки и пахового канала. Это позволит определить, на месте ли яички и при необходимости дифференцировать истинный и ложный крипторхизм.
If abnormalities are detected during palpation, additional tests will be required:
- Instrumental, such as ultrasound, CT and NMR for detailed examination of the baby's organs;
- Contrast angiography (a picture using contrast medium), which will allow to determine the location of the testicle;
- A blood test to determine hormones.
In some cases it is not possible to detect the testicles. Then they talk about anarchism or monarchism, the total absence of one or both organs.
Approximately 70% of cases of cryptorchidism occur without any treatment during the first year of life of the baby. If during this time omission did not occur, it is necessary to conduct surgical treatment. Without this, the child faces a number of serious complications:
- Ineffective infertility due to impaired sperm production;
- Impotence and shaping of the figure by the female type due to a malfunction in the hormonal function of the testicles;
- Increase of risk of oncological diseases of testis;
- Injury of the testicle or its torsion. In the latter situation, immediate surgical intervention is required, since the blood circulation in the organ is impaired.
If cryptorchidism is detected immediately after the birth of a child, doctors recommend expectant management. Most likely, the testicles will descend into the scrotum spontaneously. If the situation has not changed for the year, it is recommended treatment - medicamental or surgical.
In bilateral cryptorchidism, if the testicles are located near the scrotum, the use of hormonal drugs - chorionic gonadotropin or gonadotropin-releasing - is recommended. Enter them intramuscularly twice a week for 5 weeks. This method is used infrequently, since its effectiveness is low, and there is a risk of side effects.
In the overwhelming majority of cases of cryptorchidism, it is treated promptly. Such a surgical procedure is called orchidopexy. Carry it after the child turns a year, usually up to two years. Approximately half of the cases during the operation the doctor sees the absence of the testicles or removes them, revealing severe disorders in the structure.
This is a rather complicated operation requiring high qualification of the doctor. But if carried out correctly, it is easily transferred and rarely leads to complications.
Timely treatment significantly reduces the risk of complications. But even in this situation, about 20% of patients with unilateral cryptorchidism develop infertility. With two-way non-admission this figure reaches 70-80%. In the rest the child can normally live and develop. If the function of the testicles is broken or they are absent, the hormonal balance can be adjusted for the correct development according to the male type.