Cryptorchidism means that the testis does not descend to the scrotum, includingTesticular insufficiencyAnd ectopic testis.Clinically, most cryptorchidism is incomplete testicular descent.The ectopic testis is most often located in the superficial inguinal fossa.80% of the cryptorchidism is palpable, 20% untouchable, about 20% untouchable testis is testicular absence, and 30% is testicular atrophy.Children can retract their testes, and usually only need follow-up to prove that the testes are in a normal state without retraction.When diagnosing bilateral orchitis, it is necessary to confirm its male chromosome karyotype, and it is necessary to conduct an endocrinological evaluation to help judge whether there is unilateral or bilateral testis.
Cryptorchidism is caused by abnormal testicular descent. There are many factors causing abnormal testicular descent, including:
1. The gubernaculum of the testis leading into the scrotum is abnormal or absent, so that the testis cannot be lowered from its original position to the scrotum.
3. Luteinizing hormone releasing hormone produced by hypothalamus makes LH and follicle stimulating hormone FSH secreted by pituitary gland deficient, and also affects the power of testicular descent.Most of the cryptorchidism caused by endocrine factors are bilateral cryptorchidism, and most of the cryptorchidism caused by other factors are unilateral cryptorchidism. Sometimes cryptorchidism can be combined withOblique inguinal hernia。
clinical manifestation
Announce
edit
1. Infertility
Cryptorchidism can cause damage to germ cells, and early surgical treatment can fix the testis to the scrotum to reduce the risk of fertility reduction.The earliest postnatal histological abnormality of cryptorchidism is interstitial cell dysplasia observed in the first month after birth.The unilateral cryptorchidism after puberty should be removed, because it is prone to canceration and torsion in the future, and most of the testes lose fertility.
2. Malignant change
Children with undescended testes at birth are at risk of developing testicular malignancies.The incidence of germ cell tumors in men with cryptorchidism is about 40 times higher than that in normal people.The position of undescended testis affects the relative risk of testicular tumors. The higher the position, the greater the risk of malignant transformation.Half of the intra-abdominal testis will undergo malignant transformation.TesticularTesticular tumorThe most common type is seminoma.In cryptorchidism patientscarcinoma in situThe incidence rate was 1.7%.
90% of patients with undescended testis had patent processus vaginalis.The processus vaginalis is usually closed after testicular descent and within the first month after birth, and patent processus vaginalis is associated with a higher risk of epididymal abnormalities.The clinical significance of patent processus vaginalis is that it can affect the hormone treatment effect of cryptorchidism.
Cryptorchidism may have abnormal adhesion of gubernaculum testis, levator testis muscle or tunica vaginalis, which is easy to occurTesticular torsion。Although torsion rarely occurs in undescended testes, it should be considered in patients with abdominal pain or groin pain accompanied by ipsilateral scrotal emptinessTesticular torsion。
inspect
Announce
edit
1. Mainly for the untouchable testis, in order to determine whether the testis exists and its location, B ultrasound can be used as a routine preoperative examination.
2. CT and MRI have no advantage over B ultrasound in the diagnosis of cryptorchidism.Testicular arteriography and spermatic vein angiography are not recommended.Radiological examination of undescended testis is meaningless. In most cases, the choice of operation, the mode of operation, and the improvement of cryptorchidism function do not depend on the imaging results.
3. Laparoscopy is the "gold standard" for the diagnosis of cryptorchidism, which can be treated when positioning.
4. Bilateral or unilateral cryptorchidism with short penisHypospadiasHCG stimulation test, androgen, FSH, LH, MIS/AMH determination, chromosome karyotype, genetic gene determination, etc.
diagnosis
Announce
edit
The diagnosis of this disease is generally not difficult.Attention should be paid to the differentiation between cryptorchidism and absence of testis, which do not require surgery.
treatment
Announce
edit
The ideal age to retain fertility is 12-24 months after birth.The spontaneous descent of testis can be completed within 3 months after birth.The decisive treatment of undescended testis should be completed between 6 and 12 months after birth, which is the best time for testicular descending fixation.
1. Hormone treatment
Cryptorchidism may be accompanied by hypothalamus pituitary gonad axis abnormalities, and hormone therapy is HCG, LHRH or both.The guideline recommends that β HCG be used for the preoperative preparation of unreachable cryptorchidism or some redone cases to increase testicular blood supply and facilitate surgery.
2. Surgical treatment
If the testicle still does not descend to the scrotum 6 months after birth, surgery should be carried out as soon as possible.For adolescent cryptorchidism patients, once found, the testicular descending fixation should be performed in time. If it is found that the testicle has shrunk or cannot descend and be introduced into the scrotum during the operation, testicular resection can be performed if necessary.
(1) Open operation and testicular descending fixationThose with palpable cryptorchidism were treated with testicular descending fixation.Generally, through the groin approach, an oblique incision is made in the groin to free the spermatic cord, ligate the patent processus vaginalis or hernia sac, and place and fix the testis in the scrotum without tension.
(2) Laparoscopic surgeryIndications: all untouchable testes;Suspicious intersex diagnosis;Biopsy or intraperitoneal high testicular resection.Contraindications: acute infection, abnormal blood coagulation, previous abdominal surgery, suspected peritoneal adhesion.
(3) Autologous testicular transplantationApplicable to high cryptorchidism.Ligate the testicular blood vessels, free the testicles into the scrotum, and anastomose the testicular blood vessels with the inferior epigastric artery.This is not a widely used method and is not recommended as a routine operation.
prognosis
Announce
edit
A few undeveloped cryptorchidism developed testicular atrophy and necrosis.Azoospermia can occur in 9%~15% of unilateral and 46% of bilateral cryptorchidism patients who have successfully undergone testicular descending fixation.Surgery cannot reduce the risk of tumors, but it can make the testis easier to be examined.
