Cryptorchidism or undescended testicles- a congenital anomaly that is associated with the absence of one or both testicles in the scrotum. Instead of being located in its anatomical location (scrotum), the testicle is found in the abdominal cavity, inguinal canal, or under the skin in the genital area.

There is a dependence: the higher the testicle is located, the more pronounced the disturbances in its cellular structure are and the higher the risk of complications. So if the testicle is located in the abdominal cavity (10-40%), then surgical treatment cannot be avoided.

Manifestations of the disease. In young children, an undescended testicle does not cause pain, but is manifested only by asymmetry of the scrotum. In boys over 8 years of age, cryptorchidism causes a feeling of heaviness and aching pain in the groin and lower abdomen. Cryptorchidism is often accompanied by other pathologies: inguinal hernia, underdevelopment of the scrotum and testicles.

Statistics. Cryptorchidism occurs in 20% of premature infants and 4% of full-term newborns. By 6 months, 75% of boys with cryptorchidism have a testicle that descends on its own. By one year, only 1% of boys have an undescended testicle. Due to the anatomical structure of the body, right-sided cryptorchidism is more common - 55-70%.

Types of cryptorchidism:

• true cryptorchidism
• false cryptorchidism

False cryptorchidism also called "migratory testicle". It is found in 50% of boys under 7 years of age. This phenomenon is not dangerous and does not require treatment; it is observed with increased tone of the muscle that lifts the testicle. The testicle may “leave” the scrotum when the child is scared or cold. In adolescence, false cryptorchidism, as a rule, disappears on its own due to the narrowing of the external inguinal ring.

At true cryptorchidism The testicle does not descend into the scrotum. And it can be moved there using the method of manual reduction, making stroking movements towards the scrotum.

The absence of a testicle in the scrotum can occasionally be associated with ectopic testis - less than 5% of all cases of absence of a testicle in the scrotum. This is an anomaly when the testicle descends into the perineum, into the base of the penis, or under the skin of the thigh. Ectopia is considered the most unfavorable variant of testicular deviation and leads to male infertility.

Complication Untreated cryptorchidism in adult men leads to impotence, infertility, and testicular cancer.

Anatomy of the scrotum

Scrotum(diminutive of pouch - purse, pouch) - a sac-like formation of skin and muscles containing the testicles. In essence, it is an outgrowth of the abdominal cavity. The scrotum is divided by a longitudinal septum into two halves, each of which contains a testicle with an epididymis and a spermatic cord. The scrotum consists of several membranes:

• fleshy membrane
• fascia
• muscles.

This anatomical structure of the scrotum allows the temperature to be reduced to 34.5 degrees, which creates optimal conditions for sperm. The testicles in the scrotum are not located absolutely symmetrically. Usually one is lowered lower than the other, which avoids squeezing when moving.

Testicles– paired oval gonads located in the scrotum. These are the most important organs of the male reproductive system, responsible for the ability to reproduce and the appearance of secondary sexual characteristics (male pattern hair, Adam's apple, narrow hips, broad shoulders). The function of the testicles is to produce sperm and male sex hormones.

The testicle is divided into lobules, which contain convoluted seminiferous tubules, where sperm are produced. The epididymis is responsible for the maturation of sperm. Here they acquire the mobility necessary for fertilization of the egg. Through the vas deferens, sperm enter the prostate and from there into the urethra, which passes through the penis.

Each testicle is suspended on the spermatic cord. This soft cord stretches from the deep inguinal ring in the abdominal cavity to the upper pole of the testicle. The spermatic cord has several components:

• vas deferens
• arteries and veins supplying the testicle
• lymphatic vessels
• nerves
• remnants of the vaginal process
• levator testis muscle
• spermatic fascia - a sheath of connective tissue covering the outside of the spermatic cord

The muscle fibers that make up the spermatic cord lift the testicle closer to the body when a man freezes. These same muscles lower it lower to cool the gland. Thus, the body maintains a constant temperature in the scrotum (32.5-34.5°C), necessary for the formation of sperm. As soon as the temperature rises above 35°C, sperm production stops.

Formation of testicles occurs in the prenatal period. Initially they form in the abdominal cavity at the level of the kidneys. At 3-4 months of intrauterine development, the testicles descend. Before birth, the testicle descends along the inguinal canal - this is a gap in the thickness of the abdominal muscles in the lower abdomen, 4-5 cm long. It begins with a deep inguinal ring and ends with a superficial inguinal ring located above the pubic bone.

How does testicular descent occur? This process is ensured by the guntera cord - a ligament of connective tissue. It is attached to the scrotum at one end and to the lower pole of the testicle at the other. In the 4th month of embryonic development, the ligament contracts and carries the testicle into the scrotum through the inguinal canal. This process is facilitated by:

• increased pressure in the abdominal cavity
• increasing the level of male sex hormones (androgens) in the fetus
• bowel contractions
• work of the epididymis.

If a failure occurs in one of these links, the testicle stops on its way from the abdominal cavity to the scrotum and cryptorchidism develops.

When should the testicle descend into the scrotum? This occurs before birth or for 6 weeks after. In some cases, the testicle may take its place during the first year of life.

What happens if the testicle does not descend into the scrotum? The temperature in the gland rises and the process of formation and maturation of sperm is disrupted. Gradually, the testicle decreases in volume, atrophies and ceases to perform its functions. The production of male sex hormones stops, which leads to hormonal disorders - lack of hair on the face and body according to the male type, obesity according to the female type, decreased potency and infertility.

Causes of cryptorchidism.

The reasons for the development of cryptorchidism are not precisely known. Among them are endocrine disorders, genetic abnormalities and mechanical obstacles.

1. Chromosomal pathology
   • GTD gene mutation
   • Down syndrome
   • Noonan syndrome
   • syndrome 47
   • developmental defects of the anterior abdominal wall
   Abnormalities in chromosomes can occur spontaneously in a child or be inherited. The latter fact confirms that 23% of boys with cryptorchidism have relatives with this pathology.
2. Prematurity

   All male infants weigh less than 910 g and 20% boys weigh less than 2 kg.

   This is the immaturity of the connective tissue and ligamentous apparatus. In premature boys, the formation process is not yet complete and continues 2-3 months after birth. During this period, the testicles descend spontaneously.

3. Hormonal imbalance in the fetus
   • dysfunction of the pituitary gland in the fetus, as a result of which insufficient luteinizing hormone is produced, which is responsible for the development of the testicles
   • disorders of testicular development in the embryo
   • excess estrogen in the fetus
   These conditions cause decreased testosterone levels or sensitivity to it. Today this is considered the main cause of the development of cryptorchidism in the fetus. It is testosterone that triggers the mechanisms that ensure the descent of the testicles into the scrotal cavity.
4. Diseases of a pregnant woman
   • thyroid dysfunction
   During a woman’s illness, the synthesis of gonadotropic hormones, which stimulate the production of male sex hormones in the fetus, is disrupted.
5. Mechanical factors
   • fibrous septa in the inguinal canal
   • narrowing of the inguinal canal
   • shortening of the spermatic cord and testicular vessels
   • underdevelopment of testicular ligaments
   • cleft processus vaginalis of the peritoneum
   These characteristics of the body can be inherited. They lead to the fact that the testicle stops before reaching its natural place.

   Trauma and damage can cause acquired cryptorchidism in adulthood. For example, when wearing a bandage for a long time after removal of an inguinal hernia, or when the external inguinal ring is injured.

In recent years, a theory of autoimmune causes for the development of cryptorchidism has emerged - the immune system attacks the gonads, mistaking them for bacteria. It is believed that this reduces the tissue's sensitivity to testosterone and interferes with the descent of the testicles.

Symptoms of cryptorchidism

1. Scrotal changes
   • asymmetry
   • flattening
   • underdevelopment
   The absence of one testicle can be noticed or detected by palpation.


2. Aching and nagging pain in the groin and lower abdomen. They are associated with increased blood circulation in the testicle and compression of it by surrounding tissues. These phenomena appear in adolescence and intensify with:
   • straining
   • sexual arousal


3. Decreased sperm quality
   • decreased sperm motility
   • reducing their number
   Cryptorchidism causes an increase in temperature in the testicle and impaired sperm formation. This manifests itself in a deterioration in the quality of sperm and a decrease in its fertilizing ability.
4. Torsion of the spermatic cord(testicular torsion)

   Sharp pain in the location of the testicle, increasing over time

   The spermatic cord becomes twisted, compressing the nerves and blood vessels that support the functioning of the testicle. This can lead to necrosis (death of the testicle).

Diagnosis of cryptorchidism

Additional research methods may be needed if the testicle is located in the abdominal cavity and is difficult to see on ultrasound :

• nuclear magnetic resonance (NMT or MRI)
• selective venography
• laparoscopy

Blood analysis. For bilateral cryptorchidism, which is combined with other anomalies of the genital organs, laboratory tests are necessary:

1. Study of a karyotype (set of chromosomes) to identify genetic abnormalities


2. A test with human chorionic gonadotropin (hCG) exceeding the norm above 0.013 mIU/ml may indicate the appearance of a tumor in the testicle.


3. Determination of male sex hormones:
   • testosterone
   • follicle stimulating hormone (FSH)
   • Dihydrotestosterone (DHT)

A decrease in hormone levels may indicate dysfunction of the testicles.

Treatment of cryptorchidism

Drug therapy for cryptorchidism

Drug therapy for cryptorchidism ensures testicular descent by 30-60%. If the testicle is located close to the scrotum, then the probability of a favorable outcome is 90%. However, if it is located in the abdominal cavity, then taking medications does not bring results. In such cases, surgery is necessary.

Treatment for cryptorchidism begins at 6 or 12 months of age. A contraindication to drug therapy is when the patient reaches adolescence, when natural testosterone levels increase.

Human chorionic gonadotropin(choriogonin, pregnyl) is administered intramuscularly. Dosage: children under 10 years old, 500-1000 units, over 10 years old and adults, 1500 units 2-3 times a week for 4 weeks. If the result is positive, the course of treatment is repeated after 3 months.

Unfortunately, in 20% of patients, even after successful drug treatment, the disease returns.

Surgery

Indications for surgery for cryptorchidism

• undescended testicle – true cryptorchidism
• spermatic cord torsion
• testicular strangulation
• inguinal hernia
• ectopia testis
• testicular hypotrophy – disruption of tissue nutrition and decrease in its mass.

At what age is it better to have surgery? The operation is performed when the child reaches 9 months of age. Some doctors believe that it is optimal to perform the operation at 2 years of age - the child tolerates anesthesia relatively easily, and the testicle has not yet lost its function or atrophied. The maximum age for testicular descent surgery is 5-9 years, before puberty. During this period, the probability that the gland will produce normal sperm is lower than with surgical treatment at an early age and is 45-47%.

If cryptorchidism was first detected in adolescence or in adult men, then the undescended testicle is removed. The fact is that the gland has already lost its functions and, even with successful descent of the testicle into the scrotum, will not be able to function normally. In addition, the risk of developing a testicular tumor increases.

Contraindications for surgery

• severe chronic pathologies of the heart, liver and kidneys
• bleeding disorder

Types of operations for cryptorchidism

1. Simultaneous operation according to Schumacher - Petrivalsky. One incision is made in the inguinal canal, providing access to the testicle, and the second on the scrotum. The spermatic cord is lengthened, freeing it from the peritoneum and fibrous cords. Using a clamp, the testicle is lowered into place and fixed, suturing it to the wall of the scrotum. Both wounds are sutured.

   During the operation, a testicular biopsy is performed. If the examination reveals signs of malignancy, atrophy (decrease in volume) or necrosis (death of cells), then the testicle is removed.
   If cryptorchidism is accompanied by an inguinal hernia (20-80% of cases), then during the operation it is sutured.

2. Two-stage reduction of the testicle with its fixation to the fascia of the thigh or staged movement of the testicle. This operation is performed if the doctor discovers that the spermatic cord is short - it is stretched and does not allow the testicle to descend into the scrotum. In this case, the gland is lowered in stages, lengthening the spermatic cord.

   At the first stage, the inguinal canal is opened, the testicle is released, and the spermatic cord is lengthened. An incision is made on the scrotum and a bed for the testicle is formed. An incision is made on the thigh and the fascia lata of the thigh is exposed, to which the testicle is sutured by the tunica albuginea. Then the edges of the incision on the thigh and scrotum are sewn together.
   After 2-4 months, the second stage of the operation is performed. During which the testicle is moved into the scrotum.

Laparoscopic operations. Both types of operations have recently been performed using laparoscopic equipment. Thin tubes on which surgical instruments are attached are inserted into the abdominal cavity through small incisions. This operation allows you to reduce the recovery period by 2-3 times.

With ectopia or signs of testicular atrophy, the gland is amputated. During the operation, the surgeon may insert an implant (testicular prosthesis) and perform plastic surgery on the scrotum to restore its appearance.

Preparing for surgery for cryptorchidism

• Examination by a therapist to identify concomitant chronic diseases (sinusitis, tonsillitis, bronchitis), which can cause postoperative complications.
• A week before the proposed operation, stop taking aspirin and other blood thinning drugs that can cause bleeding.
• Blood, stool and urine tests.
• To clarify the location and condition of the testicle, an ultrasound or MRI is repeated.
• Consultation with an anesthesiologist to identify risks that may arise during anesthesia.
• The evening before surgery, take a shower. Adult men should shave their groin hair.
• Last meal in the evening, 8-10 hours before surgery. This is necessary so that the patient can tolerate anesthesia more easily.

Rehabilitation after surgery for cryptorchidism

• In the first days after surgery for testicular prolapse, antibiotics are prescribed to prevent complications.
• For pain relief, non-steroidal anti-inflammatory drugs are prescribed: Nurofen, Paracetamol.
• You can apply an ice pack wrapped in a towel over the bandage. A cold compress relieves soreness and swelling.
• The first 10 days require daily dressings. During which medical personnel assess the condition of the wound and treat it with antiseptic agents. Follow your surgeon's recommendations strictly. Do not apply any ointments to the wound, do not smear it with iodine without a doctor’s permission.
• Make sure that the incision area remains clean and dry at all times. The skin around the seam is wiped with gauze wipes soaked in soapy water and then dried.
• On days 7-12, the sutures are removed and the wound is continued to be treated with peroxide to remove crusts.
• Walking and light exercise are allowed for days 3-5. They improve blood circulation and the emotional state of the patient. Active actions must be avoided so that the suture does not come apart and bleeding begins.
• Physical activity is allowed one month after the operation.
• Adult patients need to postpone sexual activity for 3-4 weeks. Otherwise, painful sensations during sexual intercourse are possible.

Swelling and tenderness at the suture site is normal. However, you must immediately inform your doctor in the following cases:

• temperature rise above 37.5
• heavy bleeding from the wound
• wound discharge
• loosening or splitting of seams
• pain, redness and swelling around the stitch

Disease prognosis favorable if treatment is started in a timely manner. In the future, the patient will be able to lead a full sex life and become a father. In the vast majority of cases, surgery performed before 3 years of age does not leave psychological trauma.

is a congenital anomaly in which at the time of birth the boy lacks one or both testicles in the scrotum, which is due to a delay in their descent along the inguinal canal from the retroperitoneal space. The pathology is manifested by asymmetry of the scrotum, the absence of a testicle during palpation, and aching pain in the groin or abdomen. Diagnosis includes ultrasound of the scrotum, MRI, testicular scintigraphy, angiography of the abdominal aorta and venography of the testicular vein. The main method of treating cryptorchidism is surgical; the testicle is brought down and fixed to the scrotum.

General information

If it is impossible to palpate to determine the location of the testicle, they resort to performing an ultrasound of the abdominal cavity and groin area, and plain radiography of the abdominal cavity. If ultrasound is uninformative, contrast-enhanced MRI or CT may be required, and in difficult cases, diagnostic laparoscopy to confirm abdominal testicular retention or establish monorchism or anorchism. If it is impossible to palpate and instrumentally identify both testicles, it is necessary to exclude male pseudohermaphroditism, for which genetic tests, testing of testosterone, and gonadotropic hormones are carried out.

Treatment of cryptorchidism

If the pathology is false, no treatment is required. Correction of true cryptorchidism is carried out by pediatric endocrinologists and urological surgeons. Treatment for cryptorchidism begins when the child reaches 9 months of age, before this period, counting on the possibility of spontaneous descent of the testicle into the scrotum. Drug therapy is carried out using intramuscular injection of human hCG or intranasal administration of gonadorelin.

As a result of conservative therapy, it is possible to achieve testicular descent in 30-60% of patients. Hormonal drug treatment is contraindicated during puberty, when there is an increase in the level of testosterone and gonadotropic hormones. If conservative therapy fails, surgical intervention is indicated by the age of 15-24 months - orchiopexy (surgical reduction of the testicle into the scrotum).

During the operation, a testicular biopsy is required to exclude malignant processes and gonadal dyskinesia. Intervention is absolutely necessary in case of testicular torsion, strangulation, inguinal hernia, or ectopic testicle. If hypotrophy or necrosis of the gland is detected, resection of the testicle or its removal is performed - orchiectomy. In the latter case, as well as with anorchism at an older age, a donor testicle transplant or implantation of an artificial testicle is required for cosmetic correction of the defect.

Prognosis and prevention

In the case of early (up to 2 years) testicular descent or unilateral cryptorchidism, the risk of subsequent complications is significantly reduced. Infertility subsequently develops in 20% of patients with unilateral cryptorchidism and in 70-80% of patients with bilateral cryptorchidism. In the absence of at least a single, normally functioning testicle, boys require treatment by an endocrinologist for normal sexual and physical maturation according to the male type. In the future, parents, and then the teenager, are recommended to conduct a self-examination of the testicles to detect possible tumor processes. Primary prevention has not been developed.

There is a male disease with which a newborn boy may be born. This is right-sided cryptorchidism. This pathology manifests itself in the fact that when the child is born, his right testicle is not in the scrotum. In newborn boys, cryptorchidism can be either right-sided, left-sided or bilateral. In the latter case, both testicles are not located in the scrotum. But the most common, observed more often than half of the cases of this disease, is right-sided cryptorchidism. Doctors made observations, as a result of which it turned out that this pathology is more typical for premature babies. It is among them that cryptorchidism manifests itself in 30-35 boys born out of 100. In full-term babies, this disease occurs 10 times less often - from 2 to 4 cases per 100 boys born.

Problems that arise with such a paired gland as the testicle should not be ignored by parents. In many cases, this pathology is the main reason for the absence of children in men who did not eliminate it in childhood. The fact is that it is in this paired male gland that sperm and male sex hormones are formed. Therefore, various diseases of the glands have a negative impact on the formation of both sperm and male hormones, having an overall negative impact on the health of the future man.

How does pathology arise and what are the causes of its occurrence?

When the child is still an intrauterine fetus, during each of its developmental periods the testicle travels a certain path, being in one place or another in the body. For example, in an embryo, the testicle begins its journey from the retroperitoneal cavity and strives to take a position in the intra-abdominal cavity. Before the fetus is 3 months old, the testicle will be located in the lumbar region, near the kidney, slightly away from the spine. Already closer to three months of the fetus’s existence, the testicle moves closer and closer to the inguinal canal, to its internal opening. However, it will penetrate into the inguinal canal itself only when the fetus is 7-8 months old.

Once the testicle is in the inguinal canal, it tends to descend into the scrotum, following where the guide ligament leads it. This ligament has the medical name gubernaculum testis. This canal, a kind of elevator that allows the testicle to find itself in the scrotum, is a vaginal process from the peritoneum, and it is open only until the child is born. Before the world hears the voice of a newborn boy, this abdominal process closes. That is, during intrauterine life, the testicle overcomes the route from the abdominal cavity, moving through the abdominal wall and inguinal canal, ending up in the scrotum.

What causes this male gland to enter the scrotum? Firstly, it is affected by a connecting cord called Gunterov, which connects the lower pole of the male reproductive gland of the embryo with the scrotum. This cord has an active effect on the testicle, as a result of which it tends to descend into the scrotum. Secondly, this process is ensured by the disproportionate growth of the fetus and the growth of its spermatic cord. Thirdly, the testicle is affected by the pressure inside the abdominal cavity that increases during fetal development and by the movements of the intestines, in which the lower section becomes filled with meconium. This filling occurs during the period when the glands finally descend into the scrotum. Fourthly, the descent of the gonads into the scrotum is influenced by the appendage of these glands, which during development stimulates additional descent of the testicles.

During the embryonic state of the fetus, its male gonads produce male sex hormones, known under the term androgens. The testicles will move through the inguinal canal as well as the concentration of these hormones is high. One of these hormones is called luteinizing hormone. It has the greatest influence on the promotion of the gonads. The child’s pituitary gland is responsible for its production during the last three months of his intrauterine life.

During pregnancy, the mother of the child produces gonadotropic hormones. These hormones have a stimulating effect on the production of androgens in the required amount, the concentration of which directly affects the movement of the testicles along the inguinal canal. A disruption in the mother’s body’s production of gonadotropic hormones can lead to a subsequent negative process that prevents the normal descent of the gonads into the scrotum. Various physical disturbances in the fetus itself can mechanically interfere with this process, which will lead to its deviation from the expected action.

Congenital hernia as a cause of the development of right-sided cryptorchidism

It was said above that the testicle is allowed to enter the scrotum by the inguinal canal, which is a vaginal extension from the peritoneum, which is obliterated immediately after the birth of the baby. But if the process of obliteration, or closure, does not occur in this process, then this can cause the occurrence of cryptorchidism, as shown by the majority of cases of this pathology. The reason is that this hole, from a few millimeters in diameter, can increase to the size of the lumen of a rather large hernia in the groin.

This leads to the common combination of inguinal hernia and cryptorchidism. Doctors conducted an observation and, taking into account the collected statistical data, came to the conclusion that this combination occurs in 92-95% of cases. In addition to the fact that cryptorchidism occurs, the failure of the said process to heal may be accompanied by the formation of edema of the lining of the gonad (or glands), which is delayed on its way to the scrotum.

What is accompanied by the occurrence of right-sided cryptorchidism?

In addition to possible hydrocele of the testicular membranes, cryptorchidism may be accompanied by strangulated hernia. This disease is congenital; it manifests itself just during the process of lowering the testicles into the scrotum. If the above vaginal process is not closed or closed at the time of the birth of a boy, then this hole will not remain empty. The testicles may be followed by internal organs, and this process will be diagnosed by a doctor as a congenital inguinal hernia. It is believed that an inguinal hernia is possible due to an underdeveloped abdominal wall, as well as ligaments. This pathology is possible either for hereditary reasons or due to negative processes occurring during pregnancy. This hernia does not go away on its own, and when the child reaches six months of age, it is repaired surgically.

Right-sided cryptorchidism may be accompanied by torsion of the gonad, which does not enter the scrotum. And that's not it. The most severe consequence of such a pathology may be the infertility of the future man, and the risk of cancer of this male reproductive gland greatly increases. The risk of cancer especially increases in cases where the testicle is characterized by an intra-abdominal location. As for infertility, it most often develops with bilateral cryptorchidism and can occur in two out of three cases of the disease. With right-sided pathology, this percentage is lower; it is observed in every third person suffering from cryptorchidism. For these reasons, if the testicle does not return to its place by the age of 1.5-2 years, then at the age of 6-10 years it is removed to prevent more serious diseases.

Various manifestations of cryptorchidism

This disease is divided into two types - ectopia and retention. The first type is characterized by the fact that the gonad deviates from its route when traveling to the scrotum. The testicle did not go where it was supposed to go. This pathology is characterized by the fact that the conductor of the gonad, which is normally attached to the bottom of the scrotum, changes its place of attachment if it is abnormal. Since the conductor serves as a guide for the movement of the testicle, the latter changes its trajectory of movement following the conductor, does not fall into the scrotum, but deviates to the side. With this type of pathology, the spermatic cord of the gland retains its natural length.

This type of cryptorchidism can manifest itself in several ways. For example, the gland may be located above the aponeurosis of the external oblique muscles of the abdominal cavity. In this case, it is considered that we are talking about superficial ectopia. The gland may be located at the base of the penis, resting on the pubic bone, and the doctor diagnoses penopubic ectopia. If the testicle is stuck near the thigh, entering Scarpa's triangle, then this cryptorchidism will be called femoral ectopia. Stuck in the perineum, the gonad will provoke perineal ectopia.

With retention, the following violation is observed. The normal route of the gland should be observed from the point of its formation, which is located near the lower pole of the kidneys, to the external opening of the inguinal canal. In this case, the retention of the gland can be both in the intra-abdominal part, along the entire path of the testicle, and at different levels in the inguinal canal itself.

Why is it so important that the male reproductive glands are located in the scrotum?

But really, what is important in the scrotum for the testicle to be located there? Does it matter where it is stored? The main thing is that the blood flows in full. This is an incorrect judgment. The scrotum has a very important function. Some know that to prevent unwanted pregnancy, there is a folk method that advises men to take a hot bath before sexual intercourse, after which his sperm lose their activity, and the chances of a woman becoming pregnant during sexual intercourse with such a man are small. Where did such a people's council come from?

The normal process of spermatogenesis is ensured at the required temperature.

Elevated temperature will inhibit this process, preventing the consequences of sexual intercourse, such as pregnancy. Therefore, in order for a man not to become infertile, his gonads must be exposed to normal temperature conditions.

It is this necessary balanced temperature regime that is provided by the scrotum. If the testicle does not enter the scrotum, but remains elsewhere, it is exposed to higher temperatures, which leads to impaired spermatogenesis. But long before the question of sperm production arises, the problem of the normal development of this gland will arise, which also occurs only under normal temperature conditions, and if it is disturbed, there may be underdevelopment. The temperature in the body is not much, but higher than in the scrotum. The difference is up to 5°, and this is quite enough to cause disturbances in the development of the male gonads and their functioning. Nature decided to create the scrotum and place the sex glands there for a reason. This could well have been done somewhere in the abdominal cavity, saving them from the increased likelihood of injury. It was necessary to create a powerful thermostat, which was achieved.

How to identify pathology in a child?

Pathology such as cryptorchidism is not difficult to detect. Even an external examination of the condition of the scrotum will help detect the absence of one or both male sex glands. And if the glands are retained in the groin area, it may become swollen. Trying to restore the normal position of the glands through treatment and therapeutic effects on this gland and organs of the genitourinary system will lead to nothing. The pathology is characterized by significantly wider damage to internal organs, including the scrotum itself, which in such cases is distinguished by its underdevelopment of varying degrees. A differential approach to eliminating the pathology and its consequences may be required, which will require contacting different specialists, such as a geneticist or endocrinologist. It happens that the cause of the disease may be a violation of the formation of the child’s sex, and in order to identify this, it will be necessary to determine its karyotype.

But sometimes it may happen that the child exhibits some kind of reflex, called by doctors the cremasteric reflex, during which the sex gland is pulled into the inguinal canal by contracting the cremasteric muscle. Such work of this muscle can be provoked either by a stressful situation that the child is experiencing or by hypothermia. Most often this effect occurs in children aged 5-7 years. In this case, there is no question of cryptorchidism; the testicle calmly returns to its place under the influence of manual therapy. This phenomenon is called false cryptorchidism and, unlike real pathology, does not require serious medical intervention.

How to cure the disease?

The first treatment option for cryptorchidism is to administer medications to the patient. This treatment method is not very effective and helps one in five people who get sick. Of those who benefit from this treatment, 20% experience a recurrence of the disease as soon as they stop taking the medication. Doctors concluded that this method is not suitable for treating pathologies in which the male reproductive gland is located very high. Drug treatment is suitable for testicles located low to the scrotum.

Drug treatment varies greatly and depends on the degree and type of pathology. But the most interesting thing to consider for parents of boys with this condition is that there is no established evidence that one treatment is more effective than another. The standard approach is that drug treatment begins, as a rule, from the child’s six-month or one-year period of life. Human chorionic gonadotropin preparations are administered 2 times a week, and this continues for 4 weeks.

But self-medication is excluded here. Complex diagnosis, prescription and monitoring of treatment requires exclusively medical education and experience. No folk recipes for hot baths work in this case, since such methods only work on false cryptorchidism. And if the disease is real, a doctor will be needed.

As for surgical intervention, practicing doctors proceed from the following. For up to 1 year, drug treatment of diagnosed right-sided cryptorchidism can be used. There is a chance that the testicle will descend on its own, but it is very small. Further, if the pathology has not resolved by one year, doctors believe that the boy’s problem cannot be cured in the future, and they strongly recommend removing the undescended gonad. Some doctors are convinced that for right-sided cryptorchidism, treatment with hormones is considered ineffective and is not recommended. This method works best if both testicles are not in the scrotum.

There is no consensus regarding the age of a child at which surgery can be performed. The earliest is from one and a half to two years. However, at this age, children are more susceptible to the negative effects of anesthesia, which have not been observed since the age of three. Therefore, supporters of the validity of this thesis believe that surgery to remove an undescended testicle can be postponed until the child is 5-6 years old.

Cryptorchidism is a male disorder characterized by the failure of one or two 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 children have right-sided cryptorchidism at birth, 30% of newborns are diagnosed with left-sided cryptorchidism, and 20% have a bilateral form. Doctors find that in 90% of children the disease disappears on its own in the first year of life, and for 10% of children medical care is required. The higher the underdeveloped testicle is located 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 suspected causes of the development of the disease: disorders in the endocrine system, genetic failure during the formation of the fetus in the womb and an anatomical obstacle.

Cryptorchidism develops with a sharp decrease in testosterone levels

Types of disease

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

Based on the location of the testicle, the following are distinguished:

• Abdominal cryptorchidism. It is observed when the testicle is undescended from the abdominal region.
• Inguinal cryptorchidism. It is characterized by the fact that the testicle, after exiting the abdominal region into the groin area, came out and remained there.

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

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

• False cryptorchidism. Characterized by the displacement 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 normal limits. When pressing, a gap in the scrotum is felt due to the warmth of the hands, and when the muscles of the groin area are tense, the gland 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 adolescence.
• True cryptorchidism is characterized by the impossibility of returning the gland to the seminal pouch manually, as in the false form. Basically, the sex gland is located in the groin ring, less often in its canal. With this form, either both testicles or one may be retained. True cryptorchidism is often accompanied by a hernia in the groin of men, the treatment of which is only possible through surgery. The consequences of true cryptorchidism threaten male infertility.
  This type of disease is often confused with testicular ectopia, in which the gland does not enter the scrotum, but the perineum.

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

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

Based on the time of development of the disease, the following are distinguished:

• Congenital cryptorchidism. This form is observed at birth, when the baby’s gland does not descend during pregnancy. Often found in premature babies.
• Acquired cryptorchidism. The form of the disease is registered after birth. It affects boys aged 1 to 10 years.

According to the side of development of the pathology, unilateral and bilateral types of cryptorchidism are distinguished:

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

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

A boy in infancy is plagued by the following signs of illness:

• Sharp pain in the area of ​​undescended glands. The pain is replaced by an aching, nagging pain.
• Manifestation of pain when coughing, pressing, straining the body.
• Asymmetrical flat scrotum.
• Inability to detect the testicle by palpation.

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 urinating

• Urinary problems and constipation. Pain during bowel movements.
• Increased body temperature.

In adult men, the listed symptoms are supplemented by a decrease in sperm production and quantity. Pain is recorded during erection of the penis.

Diagnosis of the disease

The diagnosis of cryptorchidism is made after visual examination and palpation of the scrotum. Any underdevelopment and flatness of the scrotum indicates pathology. If during 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 using an abdominal x-ray

It is possible to confirm or refute the alleged diagnosis only after an ultrasound and radiography 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 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 case of congenital absence of the gland, the laparoscopy method is used.

In cases where children have a bilateral type of cryptorchidism, tests are necessary:

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

A blood test is a mandatory test for bilateral cryptorchidism

• Blood for analysis of hormone deficiency.
• Blood for studying the set of chromosomes.

Treatment of cryptorchidism

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

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

Conservative treatment of cryptorchidism involves intramuscular injections of choriogonin

• Surgical intervention. If treatment attempts with medications are unsuccessful, then surgery is necessary to cure cryptorchidism. Before surgery, it is necessary to perform a biopsy to exclude the consequences of oncology. The entire process takes place under general anesthesia. Surgical correction of pathology occurs as follows:
  • an incision is made in the groin area;
  • the gonad is manually lowered into the seminal sac of the scrotum;
  • an incision is made in the scrotum;
  • The gland is sutured to the walls of the testis.

In the 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 cancer.

If drug therapy does not produce results, 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 during pregnancy in the 2nd and 3rd trimester, because the disease is more common in its congenital form. The development of the anomaly is influenced by any negative factors, be it stress or a cold.

A woman who has close male relatives who have suffered from pathology needs to be especially careful. Therefore, you need to carefully plan your 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, you should avoid staying near any chemical reagents and do not take medications without consulting a doctor. For example, studies have found that taking Paracetamol increases the risk of cryptorchidism.

Complications of the disease

The causes of abnormal position of the testicle entail the following complications:

• difficulty getting blood supply to the testicle outside the scrotum;
• heat exchange disorder in the groin area;
• diseases of the genitourinary system;

Cryptorchidism causes the development of various diseases of the genitourinary system

• endocrine diseases, including discrepancies in the number of hormones in the body;
• increased risk of injury to the area where the testicle is located.

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

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

Untimely treatment of cryptorchidism may result in infertility.

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

In addition, a boy with a similar disease develops according to female characteristics: he does not grow a beard, has a soft voice, 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 video contains answers:

With proper intrauterine formation of the fetus, the formation of the testicles begins in the abdominal cavity, from where they then descend into the scrotum. This mainly occurs in the last three months of pregnancy, although sometimes the process lasts up to one and a half months after birth or even until the end of the first year of life. Because of these features, cryptorchidism is most often observed in infants born prematurely (15-30%). In children born on time, this disease is quite rare (2-4%), but in one-year-old babies it occurs in only 1% of cases.

CAUSES

The reasons for the development of cryptorchidism have not yet been clearly formulated, but there are some circumstances that may contribute to the appearance of this anomaly.

Factors that increase the likelihood of cryptorchidism:

CLASSIFICATION

Based on the time of occurrence, cryptorchidism is distinguished between primary (a child is born with an anomaly) and secondary (a testicular displacement occurs in a child born healthy).

The following subtypes of cryptorchidism are distinguished:

Sometimes another type of cryptorchidism is identified - elevated testicle when, due to too slow development of the spermatic cord, the testicle, which has already descended into the scrotum, moves upward again.

SYMPTOMS

The first and main sign of cryptorchidism is the absence of the sex gland in its proper place. Moreover, this can be detected both visually and physically - by palpation.

Aching or nagging pain with cryptorchidism is localized in the abdomen or groin. Not all types of cryptorchidism cause pain; sometimes they appear discretely - with muscle effort (during constipation, straining, sexual arousal).

DIAGNOSTICS

The main method for determining cryptorchidism is physical examination of the child by a pediatric urologist, carried out in the maternity hospital. In this case, the very absence of the sex gland in the scrotum is simply ascertained, but the localization of a displaced testicle can be difficult.

To more clearly determine the location of the testicle Ultrasound or radiography is used.

If there is a need to exclude monorchism (the absence of one testicle in the body at all) or anorchism (the absence of both testicles), contrast vasography (injection of a contrast-colored compound into the vessels), MRI or CT is used, which makes it possible to obtain a clear picture of the state of the body.

If neither manual nor instrumental methods give a reliable result, it is necessary to conduct genetic and hormonal (for the presence of testosterone and gonadotropin) studies to exclude male pseudohermaphroditism.

TREATMENT

The first time after the discovery of cryptorchidism, the doctor monitors the child. After six months of age (if independent testicular descent has not occurred), hormonal therapy is most often prescribed - intranasal or intramuscular administration of special hormones. Normalization of the position of the gonad occurs in 30-60% of small patients. In advanced cases (upon reaching the age of puberty), conservative therapy is contraindicated due to the increased secretion of the body's own hormones.

If drug treatment does not produce results, then after a year (often at the age of 15-24 months), surgical intervention is prescribed.

As a preliminary procedure, a testicular biopsy is required to determine its morphological changes. An incorrectly located testicle is exposed to higher (1.5-3°C) temperatures, as well as other unfavorable factors, which can lead to undesirable consequences, for example, tissue malignancy. Therefore, if malnutrition, malignant changes, gonadal dyskinesia or necrosis of the gonad are detected, its resection (removal) is performed - orchiectomy. Unfortunately, such an operation has to be performed in approximately half of cases of surgical treatment. The remaining 50% of patients undergo surgical reduction of the testicle into the scrotum - orchiopexy.

Boys who have had an orchiectomy may later have a gonad transplant or a cosmetic procedure involving the implantation of an artificial testicle.

COMPLICATIONS

The longer the testicle is exposed to unfavorable conditions, the higher the risk of its pathological degeneration.

The most common complications of cryptorchidism are:

• spermatogenesis disorder(production of male germ cells) - a decrease in the number of sperm and a decrease in the quality of sperm, up to complete infertility (with bilateral cryptorchidism, infertility is observed in approximately 70% of patients);
• hormonal imbalance- due to insufficient production of male hormones, the development of boys is to a lesser or greater extent according to the female type (excessive body weight, delayed or inadequate manifestation of secondary sexual characteristics), as they grow older, impotence develops, and psychosexual disorders may be observed;
• higher (35 times) probability of malignant pathology - seminomas(testicular cancer);
• testicular injury when it is located in the groin;
• volvulus(torsion) of the testicles;
• the occurrence of inguinal or umbilical hernia.

PREVENTION

There is no specific prevention for cryptorchidism. The main measure is to maintain a healthy lifestyle by a pregnant woman. It is necessary to exclude the possibility:

• hormonal imbalances (for example, avoiding stress);
• infection with viral diseases;
• the influence of harmful chemicals and medications (especially when taking anti-inflammatory and painkillers).

PROGNOSIS FOR RECOVERY

The return of the testicle to the scrotum (independently or as a result of treatment), which occurs before the age of two years, gives high percentage of exclusion of abnormal child development. Moreover, the sooner the correct position of the cryptorchid testicle is restored, the lower the risk of developing pathologies. However, with bilateral cryptorchidism, there remains a high probability of subsequent infertility - up to 80%.

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