Cryptorchism

December 21, 2011

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Cryptorchism   - A condition typical of the male, the presence of which one or both testicles are not in the scrotum. During fetal development the boy's testicles are in the abdomen. In normal fetal development for some time before delivery boy testicles descend into the scrotum. Therefore, a full-term healthy baby at birth or soon after birth testicles already defined in the scrotum. The word "cryptorchidism" comes from Greek and means "hidden eggs". If this phenomenon can be located in the testicles inguinal canal , at abdomen . It may also be lowering their wrong when a testicle after leaving the inguinal canal starts to fall in the wrong direction and eventually turns out to be either groin   under the skin, or a hip , at perineum   or pubis . Due to the structural features of the human body more frequently recorded instances of right-of cryptorchidism .

According to modern statistics, testicle in the scrotum are absent in 2-4% of children born full-term, at 15-30% of premature babies and 1% of children aged 1 year. Approximately 60% of the possible palpation of the testis, which descended into the scrotum. A ten percent of children diagnosed with a bilateral cryptorchidism doctors. Also rare cases monorchism or anorchia, that is, the absence of one or both testicles in the child.

Causes of cryptorchidism

During fetal development the male first laid his testicles in the abdomen. If the correct bookmark sex of the child and its subsequent development without the development of testicular pathologies and their subsequent descent into the scrotum occurs to six months before birth to sixth week of life the baby after birth. In some cases, depending on the genetic characteristics, this process can last up to one year of age of the child.

The reason for violations of this process is often a chromosomal abnormality that occurs as a result of external influences of chemicals transferred pregnant woman viral diseases (in this case highly undesirable toxoplasmosis . flu . rubella   or venereal diseases ). Trigger the development of cryptorchidism may be the emergence of hormonal imbalance and the mother and the fetus. Cryptorchidism, which is considered a symptom of intrauterine growth retardation in some cases may be accompanied by other congenital abnormalities. For example, a child may experience an extended nose, the presence of dysplastic ears, pathology, spine and chest, malocclusion and atypical shape of the skull, umbilical   or inguinal hernia .

Also, the reason for the subsequent development of cryptorchidism can serve as a pregnant woman eating some painkillers. It is desirable treatment aspirin . ibuprofen . paracetamol . Especially great is the risk of receiving the two drugs simultaneously. Thus, according to the research, receiving two such medicines at the same time increases the probability of the birth of a child with cryptorchidism, sixteen times.

More often cryptorchidism seen in children who are born with low birth weight and infant of twins, triplets.

Types of cryptorchidism

With true cryptorchidism   observed the following features: in the process of being relegated hand it is impossible to move the testicle into the scrotum. In this case, the egg is in the groin, the inguinal canal, abdominal cavity, or at the top in the middle of the scrotum. This disease is treated with surgery.

With false cryptorchidism   egg may degrade in the scrotum, regardless of where it is located. This pathology is very common, and its cause is too much muscle tone, which is responsible for raising the testicle. A child in the first months of life, this muscle is not reduced at all, at the same time to two years in its tone becomes higher, and up to eight years of age of the child, he is the maximum.

When a state that is called testicular ectopia , It is found in the crotch area, on the hip, at the root of the penis, groin. In this case, the egg can not relegate into the scrotum.

In some cases, a testicle that has already descended into the scrotum, displaced because of too slow growth of the spermatic cord.

Diagnosis of cryptorchidism

In time to diagnose and subsequently treat the disease, there should be a thorough investigation immediately after birth. To conduct the survey must be in a warm room. Dr. fingers of one hand holds the baby scrotum, while the other hand holds palpation. In the absence of a testicle in the scrotum palpable inguinal canal. Upon detection of a testicle in the inguinal canal specialist trying to reduce it in the scrotum. In this case, simply made the differential diagnosis between true and false cryptorchidism.

In the process of diagnosis of cryptorchidism is also used MRI or ultrasound of the abdominal cavity and pelvis.

To determine the absence of one testicle (monorchism) or complete absence of testicles in general, should conduct a special study called contrast angiography. Its essence lies in the fact that the receptacles are administered a contrast agent, after which a snapshot is produced. With such a study to determine easily the egg, which is in the abdominal cavity and is not detectable during palpation.

Complications of cryptorchidism

To date, studies have shown that when undescended testes in their morphological changes occur in the period of development of the fetus in utero. Thus, for normal spermatogenesis requires special temperature conditions (the temperature must be 1, 5-2, 5 ° C lower than in the abdominal cavity). Such conditions are provided in the scrotum. Accordingly, the higher is abdominal egg, the more it is influenced by high temperatures, and accordingly suffers reproductive function.

Over time, as violations occur androgenic function. Due to abnormal hormone boys have a child suffering from overweight Their secondary sexual characteristics do not develop in time. So, very slowly growing beard and mustache, very weak body hair in the groin, remains high voice. As a result, a child grows effeminate and later he may develop impotence .

Experts note that often with undescended testes also observed in a patient umbilical or inguinal hernia. In the presence of such a disease the patient should immediately consult your doctor to perform surgery. Patients who suffer from bilateral cryptorchidism, usually diagnosed male infertility : Only 30% of patients with this disorder are fertile.

Much higher is the risk of malignant transformation undescended testicle. The most dangerous complication that can occur when such a disease is gonioma   (testicular tumor). Also, as possible complications volvulus testicle, testicular trauma.

Treatment for cryptorchidism

If, before the age of two the child's testicle has not descended into the scrotum, it requires surgical intervention. During the operation about half the experts determine that the egg remains unchanged. In such a case applicable orchidopexy . In other cases, doctors do not reveal an egg or remove it occurred due to changes in its physiological nature.

If orchiopexy hold at an early age, this operation helps prevent infertility, correct inguinal hernias, often accompanying cryptorchidism, prevent injuries and testicular torsion of the active child. Making timely surgery can help prevent mental health disorders in adulthood, as well as significantly reduce the risk of malignant transformation. The optimal age for such an operation is the age of 12-18 months. Generally, the operation takes place without complications, and a few days later the baby is discharged from hospital.

Practice in the treatment of cryptorchidism and hormonal therapy, but it is used only when a false cryptorchidism. Assign course of hormone treatment after the baby is six months old. Sometimes conducting hormone replacement therapy is also necessary before surgery.

Prevention of cryptorchidism

Today is known about the direct methods of preventing this disease. However, reducing the risk of cryptorchidism careful preparation and planning for a future pregnancy. So, you should completely cure all chronic infectious diseases, avoid stress and heavy physical exertion. It is important not to contact with dangerous chemicals in the first months of pregnancy during the laying of the unborn child. Do not use non-narcotic analgesic agents with influence.