Cryptorchidism is congenital scrotum without testis, including testicular hypofunction, ectopic testis and testicular loss. About 4 ~ 10% of newborn boys' testicles did not completely fall into the scrotum at birth, and continued to decline after birth. By 1 year, the incidence of cryptorchidism is only 1 ~ 2%, and it is about 0.4% in adults. Unilateral cryptorchidism is more than bilateral cryptorchidism, which is about 5∶ 1.
What causes cryptorchidism?
There are two theories about the causes of testicular hypoplasia: 1. Endocrine factors: If the mother's chorionic gonadotropin is insufficient or the testis itself is defective, it will often cause bilateral testicular hypoplasia if she does not respond to this hormone. 2. Mechanical factors: such as short spermatic vein, poor development of testicular lead or inguinal canal, adhesion between testis and retroperitoneal tissue, variation of levator testis, etc. Hinder testicular descent. This condition often leads to unilateral testicular insufficiency.
What are the symptoms of cryptorchidism?
Long-term retention of testicles in abnormal positions will have adverse consequences:
1. testicular atrophy: Testicles do not descend into scrotum, and only slight tissue changes occur within 2 years after birth, which will cause testicular hypoplasia or atrophy after 2-5 years old. Bilateral cryptorchidism can make 90% patients infertile.
2. Malignant transformation: The risk of malignant transformation of cryptorchidism patients is 20 ~ 48 times greater than that of normal scrotum; The risk of testicular malignant transformation in abdominal cavity is 5 times greater than that in inguinal testis. Congenital defect of testis, abnormal position of testis and high environmental temperature are the reasons for malignant transformation of cryptorchidism.
3. Vulnerable to trauma: the testicles are located in the scrotum, which is more mobile and less likely to be injured. The testicles are located in the groin. When the abdominal muscles contract, the inguinal canal contracts and the testicles are squeezed. Testicles in abdominal cavity are often squeezed by changes in abdominal pressure.
4. Testicular torsion: The testis of cryptorchidism may have abnormal testicular lead, abnormal adhesion of levator testis or abnormal adhesion of testicular tunica vaginalis, which is prone to testicular torsion.
5. Others: About 65% of cryptorchidism patients are complicated with indirect hernia.
6. An empty scrotum can lead to inferiority, mental depression and withdrawn personality.
What tests does cryptorchidism need to do?
Patients with cryptorchidism often come to see a doctor because the scrotum is empty and there are no testicles in it. There are also patients who complain of "hernia", or patients who come for examination because of bilateral cryptorchidism and infertility after marriage. Diagnosis is generally not difficult. However, attention should be paid to the differentiation between cryptorchidism and testicular loss, because the latter does not require surgery.
If the patient's chromosome is XY type, the serum follicle stimulating hormone (FSH) is increased, the serum testosterone (T) is decreased, and the testosterone level does not respond to the stimulation of chorionic gonadotropin (HCG), it is bilateral testicular loss, and no surgical exploration is needed.
For unilateral testicular loss, which is difficult to be diagnosed before operation, hormone detection is normal. Genital venography, laparoscopy, B-ultrasound and CT scanning may be helpful for diagnosis, and surgical exploration is still needed if necessary.
How to treat
(1) Endocrine therapy: bilateral cryptorchidism can be treated with chorionic gonadotropin first, and hormone therapy before 3 ~ 5 years old. If hormone therapy is ineffective, it is not suitable for continued application or repeated application, and surgery should be changed.
(2) Surgical treatment: Unilateral cryptorchidism or bilateral cryptorchidism should be treated surgically.
1. Timing of operation: It is suggested that the age of testicular fixation is getting earlier and earlier. At present, it is considered better to have surgery before the age of 2. For low cryptorchidism, surgery can also be performed before the age of 6.
2. Operation method: Find the testis through oblique inguinal incision, fully free the spermatic cord and vas deferens, and fix the testis in the scrotum. If bilateral cryptorchidism cannot be fixed in scrotum, one testicle should be preserved and placed under the skin as much as possible to preserve its endocrine function. For unilateral cryptorchidism after puberty, especially for high cryptorchidism that cannot reach the testis, orchiectomy should be done to prevent canceration.