Cryptorchidism in children is a congenital pathology in boys, in which one testicle, and sometimes both, does not descend into the scrotum. They may remain in the inguinal canal, in the abdominal cavity, or in the upper part of the scrotum. This is a common disease in pediatric urology, which affects about 4% of full-term boys and about 20% of premature infants. Such a large difference in percent is due to the fact that the testicles descend into the scrotum in late pregnancy, almost before childbirth. If childbirth began earlier than the due date, then this phenomenon did not have time to occur. But still, in most children, by the end of the first year of life, the problem disappears on its own, as the testicles descend into the scrotum on their own. In other cases, surgical intervention may be required, since in the future undescended testicles can lead to serious consequences, such as infertility and cancer.
Photo cryptorchidism in children
Below is illustrated material to help you imagine what the disease looks like.
It is very important to know what the disease is in order to identify it in time and begin treatment.
Classification
Depending on the location of the testicles, cryptorchidism is classified as:
- Abdominal - when the testicle is found in the abdominal cavity. In the diagnosis, sometimes even an ultrasound can not locate the testicle. It is treated only by the operational method.
- Inguinal - at the location of the testicle in the groin.
- One-sided - when one testicle did not fall.
- Bilateral cryptorchidism in children - with undescended two testicles in the scrotum. Sometimes it occurs with hormonal disorders at the stage of intrauterine development. In this case, it is very important to start treatment as soon as possible, without waiting for the action of hormonal therapy, since with bilateral undescended treatment, the death of cells involved in sperm production is about 70%.
In most cases, right cryptorchidism is detected.
Also distinguish:
- True form - when undescended testes were discovered immediately after birth
- False cryptorchidism in children - when at birth the testicles were palpated in the scrotum, but after a while the doctor could not identify their correct location. This form of cryptorchidism does not require treatment and takes place at the beginning of puberty of the boy.
- Ectopic testis - when the testicles descended, but not into the scrotum, but into areas uncharacteristic for this (groin, pubis, perineum, hips, etc.). Often this occurs due to mechanical obstruction. Unfortunately, with this form of the disease, even after treatment, most of the boys remain infertile.
- Recurrent cryptorchidism is a pathology in which, due to a lag in the development of the spermatic cord, the testes repeatedly rise up from the scrotum
After the classification of cryptorchidism, the doctor decides on the further treatment of the child.
Causes of Cryptorchidism
At this time, the exact causes of this pathology are unknown. Doctors identify only a number of factors that can lead to such an anomaly in babies:
- chromosomal abnormalities;
- genetic predisposition;
- premature birth;
- hormonal disorders in the mother during pregnancy (diabetes mellitus, disorders of the thyroid gland);
- multiple pregnancy;
- toxic effects on the fetus (alcohol, smoking, taking medications that are prohibited during pregnancy);
- viral diseases during pregnancy;
- narrow inguinal passage or short spermatic cord, etc .;
- more than 80% of cases of undescended testis coincides with the presence of congenital inguinal hernia.
If during the period of bearing a child at least a couple of the above factors are found, more careful monitoring of the development of the baby is required.
It is proved that with the future mother observing the regime of rest and nutrition, the risk of cryptorchidism in children is significantly reduced.
Methods for diagnosing cryptorchidism
The presence of cryptorchidism in a boy is diagnosed by a urologist. Determine this pathology, as a rule, is not difficult. The following methods are used for diagnosis:
- Examination and palpation of the scrotum, inguinal region. It is very important that the office is warm, as in a cool room reflex testicular lift may occur due to muscle contraction.
- If, upon examination, the doctor notes the absence of one or two testicles, an ultrasound examination of the inguinal and abdominal areas using dopplerography is prescribed.
- In more severe cases, an MRI or KTR procedure may be recommended (basically such an analysis is prescribed if one or two testicles are completely absent).
- Blood test for hormones.
- Sometimes laparoscopy is recommended for diagnosis.
It is worth noting that palpation of the testicles should be carried out in the hospital. And if undescended is detected, this diagnosis is indicated in the statement of discharge. But an inattentive examination of this part of the body in a child leads to the fact that children are discharged without specifying the presence of this problem. In this regard, parents may not know until a certain age that their son needs control and treatment. In the presence of advanced cryptorchidism, a boy may have problems. Therefore, it is recommended to independently examine the inguinal region of your baby in order to consult a specialist in time.
Symptoms of Cryptorchidism
Here's what you need to pay attention to:
- On examination, one or two testicles are not palpable in the scrotum.
- Drawing pain in the groin. But pain or discomfort during urination is not observed in newborn babies or in older boys.
- When probing, you can find a testicle in the abdominal cavity, in the thigh or in the perineum.
- Asymmetry of the genitals.
Complications of cryptorchidism
It is important to understand that cryptorchidism is a very serious disease that requires mandatory timely treatment. The most dangerous complications of this disease include:
- Testicular injury. If the location is uncharacteristic for him, the testicle can be damaged even by lightly pressing it.
- Inguinal hernia, which can be a serious threat to the boy's life (threat of infringement).
- An undescended testicle sometimes becomes the site of inflammatory processes.
- Hormonal disruptions. With cryptorchidism in a child, male hormones are suppressed.
- Torsion of the testicles. With this complication, emergency surgical intervention is necessary. It is characterized by acute pain and impaired blood supply.
- Infertility. Sperm production requires a certain temperature regime, which is present in the scrotum. If the testicle is in another area of the body (with fever), then the sperm production process is disrupted. There are times when sperm ceases to be produced at all.
- Testicular cancer. With the development and absence of treatment inside the organ, mutations occur that can provoke the development of malignant tumors.
With cryptorchidism, the risk of infertility increases by 70% of cases, and testicular cancer - by 80%.
Note that the above complications may occur with complete neglect of treatment or with late detection. Otherwise, this ailment is completely treatable.
Treatment
Treatment of cryptorchidism in children begins with undescended testicle after six months of age. But basically, if at birth one or two testicles was not in the scrotum, they descend there until the baby reaches one month of age. In premature infants, this period can be increased to 12 months. At this time, the control of the doctor is very important.
Treatment of cryptorchidism in children is possible in two ways:
- conservative;
- operational.
With the conservative method, medication with hormonal drugs is prescribed. Intramuscular administration of hormones such as gonadotropin releasing hormone and hCG are used. In addition to this, the endocrinologist prescribes a number of vitamins.
As a result of this method of treating testicular prolapse, it is possible to achieve in 50-60% of cases. But some doctors do not recommend using this method in children with unilateral cryptorchidism, when one testicle is healthy and functioning normally, because large doses of hCG can negatively affect it. With intensive hormone therapy, early puberty may begin .
With false cryptorchidism, along with hormonal therapy, the doctor may try to lower the testicle into the scrotum by palpation.
If the conservative treatment method has not yielded results, a surgical intervention is called an orchipexia. Cryptorchidism in children is treated with surgery at the age of not earlier than 2 years. But some experts insist on carrying out the procedure until the child reaches one and a half years.
In the treatment of cryptorchidism in children, surgery can be performed in two ways:
- open operation;
- laparoscopy.
The open method is used when a pathological testicle can be felt. Here, a very important point is the determination of the length of the spermatic cord. If it turns out to be short, then about a month before surgery, a course of hormonal drugs is prescribed.
Many parents wonder: if cryptorchidism is found in a child, how does the operation go? With open intervention, this happens as follows:
- first, an incision of about 2-3 cm is made in the inguinal region;
- then the surgeon searches for the testicle;
- if it has atrophied, it is removed;
- then an incision is made on the scrotum, in the place where the testicle will be transferred;
- the actual transfer of the organ and its hemming to the wall of the scrotum;
- suturing.
The laparoscopic method is used when it was not possible to locate the organ or when both testicles were not empty. The operation is performed with a special device - a laparoscope. A device is inserted through the navel of the patient and a testis is searched:
- if a testicle of standard sizes is found, and the spermatic cord is of sufficient length, the organ is lowered into the scrotum;
- if the testicle is found, but the spermatic cord is short, then the vessels of the organ with a defect are clipped, and the operation itself is postponed for 6 months;
- in the absence of a testicle, implantation is performed (but it is worth noting that this applies only to adult men, children undergo implantation surgery only after they have reached puberty).
It is worth noting that with bilateral cryptorchidism, a two-stage operation is recommended. First of all, they lower the testicle that is closer to the scrotum. In this case, there is a possibility of its hormonal beneficial effect on another testicle. There are many positive reviews about the operation of bilateral cryptorchidism in children. But in this case, it is very important to start treatment as soon as possible.
As a rule, such an operation lasts no more than 90 minutes. It is performed under combined or local anesthesia. The patient is discharged after 2-3 days, very rarely required control within a week.
Operation with a laparoscope halves the recovery period.
If one testicle had to be removed or it was not at all, the endocrinologist should prescribe hormone therapy for the correct development of the male male type.
Contraindications for surgery
There are few contraindications to conducting orchidia. But they are worth considering. Surgery is not recommended for systemic diseases and for bleeding disorders.
Preparation for surgery
Any surgical intervention requires some preparation. Preparing for orchipexy is as follows:
- examination of the pediatrician, the identification of diseases that are a contraindication to surgery;
- analysis of urine and blood;
- in a week you need to cancel all drugs (including aspirin), which can contribute to blood thinning;
- MRI and ultrasound;
- within 8-10 hours you can not eat food;
- Be sure to talk with the anesthetist to eliminate the risks during surgery.
Possible complications during surgery
Numerous positive reviews of surgery for cryptorchidism in children make it clear the safety of the procedure. But there are exceptions. In rare cases, the following are possible:
- bleeding
- infection in the incision site;
- improper location of the testicle during surgery;
- scrotal edema;
- injury to the spermatic ducts and blood vessels that provide nutrition to the testicles.
Postoperative Recovery
After the operation, the child remains under observation in the hospital for up to three days. In rare cases, they decide to stay in the hospital for up to a week. For about a month, outdoor games, sudden movements, and weight lifting are not recommended.
A week later and every subsequent month until six months after the operation, it is necessary to see a doctor.
Prevention
Since the development of cryptorchidism begins in the prenatal period, preventive measures are aimed at the expectant mother:
- need to lead a healthy lifestyle;
- try to protect yourself from infectious diseases;
- do not take drugs that are prohibited during pregnancy;
- Do not be near the spray of chemicals;
- Follow the instructions of your doctor.
Conclusion
It is very important to notice the absence of the testicle in the scrotum in time, because the longer the treatment is not carried out, the less likely it is to maintain reproductive function in adulthood. This is especially true for children with bilateral cryptorchidism. In this case, even after treatment, up to 70% of spermatogenic cells die. With unilateral - up to 20%. With ectopia, as a rule, the testicle is removed.
If the doctor recommends a surgical method when confirming the diagnosis, there is no need to be afraid. As a rule, children tolerate the operation well, and recovery is quick. But in this matter a well-coordinated tandem of several specialists is needed - a pediatrician, urologist, endocrinologist.
All reviews of cryptorchidism in children indicate the importance of timely treatment of this pathology.