Cryptorchism

Description:

The cryptorchism is a state at which one or both small egg are not in the place in a scrotum. At pre-natal development testicles are located in an abdominal cavity of a fruit. Normal shortly before childbirth testicles fall to a scrotum and at the full-term child at the birth or in the first days after the birth testicles have to be defined in a scrotum.

The cryptorchism quite often meets in children's urology. So, it is diagnosed for the full-term children in 3% of cases, and at premature - in 30%. However after a year of life of the child respectively at 75 and 90% of children testicles independently fall to a scrotum, and the general frequency of a cryptorchism in population at one-year-old age makes 1-2%. The bilateral cryptorchism takes place at 10% of patients.

Cryptorchism symptoms:

Classification of the states interfaced to lack of one or both testicles in a scrotum is carried out depending on a small egg arrangement as follows:

  1. An intra belly cryptorchism (10% of cases) - the small egg is located proksimalny an internal abdominal ring in an abdominal cavity.
  2. The Ingvinalny (pakhovy) cryptorchism - the small egg is located in the inguinal channel between an outside and internal abdominal ring.
  3. A small egg ectopia (5% of cases) - the small egg is located distalny an internal abdominal ring, but out of the usual way of omission to a scrotum. Most often the malrelated small egg is found in inguinal area (an inguinal ectopia), in a crotch, on a hip (a femoral ectopia), in a penis root, over a bosom and, occasionally, in an opposite half of a scrotum.
  4. An anorchism (4% of cases) - inborn lack of testicles.
  5. The wandering small egg (a false cryptorchism) - strictly speaking, is not manifestation of a cryptorchism. At this state the high reflex of a cremaster - the muscle lifting a small egg takes place. The Kremasterny reflex has the greatest activity aged from 2 up to 7 years. The small egg usually is defined in subingvinalny or premoshonochny area and can back without effort be placed in a scrotum.

Diagnosis. Examination of the patient in the absence of a small egg in a scrotum is conducted in the warm room. Fingers of one hand have at the scrotum basis, preventing small egg shift, other hand carry out a palpation. If there is no small egg in a scrotum, then palpate the pakhovy channel (in the direction from an upper front ileal awn down and medially to a pubic hillock), a crotch, nadlonny area and the femoral channel. If the small egg is at an exit from the inguinal channel, it is delicately tried to be reduced in a scrotum that allows to carry out differential diagnosis between a true and false cryptorchism. To distinguish a cryptorchism from inborn lack or an ectopia of a small egg, it is carried out ultrasonography or MRT of an abdominal cavity and bodies of a small pelvis. If the small egg is not palpated, in some cases the laparoscopy with the subsequent bringing down of a small egg in case of detection it in an abdominal cavity is carried out. In the absence of the palpated testicles on both sides before operational manipulations test with introduction of a chorionic gonadotrophin and determination of basal level of follicle-stimulating (FSG) and luteinizing (LG) of hormones is shown. In the absence of increase in level of testosterone in response to introduction of a chorionic gonadotrophin and the increased FSG and LG basal levels the diagnosis of an anorchism authentically is established.

Cryptorchism reasons:

The etiology of a disease is unknown.

The great value of this nosology is caused by the fact that at a cryptorchism:

  1. The risk of development of cancer of a small egg is 20-40 times higher. 10% of cases of total number of testicular cancer develop in the neostarted-up small egg. The probability of development of cancer is 4 times higher at an intra belly cryptorchism, than at ingvinalny (inguinal).
  2. Fertility is broken. Only 30% of patients with a bilateral cryptorchism are fertile. Disturbances of fertility are more expressed at higher arrangement of a small egg and more long stay it out of a scrotum.
  3. The accompanying scrotal hernia meets more often.
  4. The risk of torsion of a small egg, especially in the post-pubertal period is increased.

Treatment of the Cryptorchism:

The purpose of treatment of a cryptorchism is recovery of normal provision of testicles before the 2nd year of life of the child as if in 2 years the small egg did not fall to a scrotum, there is an irreversible disturbance of a spermatogenesis. Conservative methods of treatment of a cryptorchism assume use of a chorionic gonadotrophin or rileasing-factor (rileasing-hormone) of luteinizing hormone. Efficiency of hormonal therapy makes 20-30%. At a small egg ectopia it is inefficient, however can be used for improvement of a condition of fabrics before operation.

Quite often at a cryptorchism at once recommend operational treatment, especially, if it is about an arrangement of one or both testicles in an abdominal cavity, an ectopia of a small egg or a combination of a cryptorchism to inguinoscrotal hernia, not fusion of a vulval shoot and other anomalies. Operations of the choice are орхидофуникулолизис (release of a small egg and seed cord from surrounding fabrics) and an orkhipeksiya (fixing of a small egg in a scrotum after preliminary bringing down). Orkhipeksiya at early age reduces risk of development of cancer of a small egg. At rough morphological changes removal of a small egg is made. The best age for operation of an orkhipeksiya - 12-18 months.