Cryptorchidism - Causes, symptoms and treatment. MF.

Cryptorchidism is a congenital abnormality of the genitourinary system of a man, which is manifested by the absence of a testicle in the scrotum. Distinguish between false and true cryptorchidism. At the first testicle, the manual method can still be moved to the scrotum, while the second one is firmly fixed under the skin of the thigh or in the abdominal cavity.

Causes of cryptorchidism

The most common cause of cryptorchidism is congenital chromosomal pathology. It can develop against the backdrop of infections carried by a woman during pregnancy. A group of diseases that can lead to congenital cryptorchidism include infectious diseases such as influenza, toxoplasmosis, or rubella. In addition, cryptorchidism can develop from the effects of a variety of chemicals on the fetus during pregnancy. As the latter can act chemical dyes, detergents, products of oil refining or some types of medicines. As for the latter, with regard to cryptorchidism, non-narcotic analgesics are considered to be the most dangerous: paracetamol, aspirin, ibuprofen and similar drugs.

Symptoms of cryptorchidism

As a rule, the signs of cryptorchidism do not leave unnecessary questions in the diagnosis. Symptoms are manifested by the complete absence of a testicle in the scrotum at the birth of a boy. Quite often in the hospital, the scrotum of an infant is left without attention, and such children are safely discharged home. Subsequently, serious problems can arise, so it is necessary to periodically examine the scrotum of your child in order to timely suspect the pathology.

In many cases, even timely access to a urologist does not help to save the testicle. But this does not mean that such a situation can be left without attention. The fact is that if the undescended testicle is in the abdominal cavity of the baby, then it can activate the immune processes that will adversely affect the other gonad. To prevent this, a timely consultation of the urologist is needed, which can correctly choose the tactics of management and treatment of such a child.

Diagnosis of cryptorchidism

Laboratory indices do not suffer much during cryptorchidism. Unless at the stage when the autoimmune reaction develops, a sharp increase in the amount of C-reactive protein and other inflammatory agents can be observed in the patient's blood.

Much more often during cryptorchidism, is produced by .His task is to find out exactly where the undescended testicle is located. Of course, if the organ is located under the skin of the pubis or thighs, then there is no need for an ultrasound examination. But if it is located in the abdominal cavity, ultrasound is simply necessary. The main goal of this study is to exclude a pathology called testicular anemia. This problem lies in the congenital absence of one of the testicles. In this case, surgical intervention is of no use, while in cryptorchidism it is simply necessary.

Another special method of investigation is the vasograph , which consists in the radiographic examination of contrasted testicles. With the help of this method it is possible to find out not only the position of the organ, but also the degree of its anatomical and functional maturity, which is also necessary for choosing the further tactics of managing the patient.

Treatment of cryptorchidism

Treatment of cryptorchidism is divided into surgical and conservative. An operative correction of the pathology is applied in the case if during the first two years of life the testicle did not fall independently into the scrotum. In this case, tactics of operative intervention is solved in the course of the process itself. If the organ is not changed, but simply is not in its place, then perform an orchid surgery, when the testicle through the scrotum is fixed to the skin of the thigh. If serious morphological changes are detected during the operation, they resort to the removal of the testicle.

Orchid surgery

Practice shows that the best treatment results are observed when the orchipexy is performed at an early age. In such a situation, in almost all cases, infertility is prevented, oblique inguinal hernia is corrected, the testicular torsion is prevented, and the child himself receives a lesser psychological trauma, which is especially pronounced if such an operation is performed in adolescence.

In early childhood, correction of cryptorchidism by hormonal therapy is possible. The introduction of chorionic gonadotropin begins at 6 months, when it is still possible to achieve an arbitrary lowering of the testicle in the scrotum. The last term is considered to be a two-year age, when the question of the need for prompt intervention must finally be decided.

Features of diet and lifestyle with cryptorchidism

Cryptorchidism is one of those pathologies that do not require specific nutrition. As for the way of life, children who have a similar problem should be better protected from excessive traumatization, which is especially dangerous if the undescended testicle is under the skin of the hip or abdomen.

The same applies to the period after the operation, during which the child should be limited from too lively games. Otherwise, there may be a discrepancy between the operating wound or the detachment of the testicle fixed to the hip.

Rehabilitation after illness

In the first place nevertheless there is a psychological rehabilitation after the transferred operation. Especially relevant is when surgical intervention is performed at an older age. Such children quite often close themselves, feeling inferiority to their peers. This leads to the emergence of a large number of complexes, including those related to sexual activity. That is why urologists strongly recommend conducting such surgical interventions even before the beginning of the child's conscious life, that is, in early childhood.

If, for some reason, the correction in infancy did not work and the teenager is going to have such an operative intervention, then it is advisable to begin psychological rehabilitation before the operation itself. This will help the youth to properly understand their problem and tune in for the upcoming test.

As a rule, such children are engaged in children's psychologists and psychotherapists. It is enough only a few sessions of such therapy in order for the child to look at the problem differently. It would also be good for the school company to come up with another official version, since the reaction of schoolchildren to such an operation may also not be quite adequate. In general, the problem of psychological control in this case is quite serious, but with the right approach it can be minimized.

Treatment of cryptorchidism with folk remedies

In the arsenal of folk healers there will be funds absolutely for all occasions. With regard to cryptorchidism, they offer different lotions and compresses that not only can not help the sick body, but also quite easily can damage a healthy testicle. Whatever it was, even if you are not adherents of traditional medicine, treating cryptorchism with folk remedies is strictly prohibited. In such a situation, it is better to do nothing more than to use the inactive means of traditional healers.

Complications of cryptorchidism

For a normal development of spermatozoids, a temperature 2 degrees lower than in the human body is needed. It is this environment that is created in the male's scrotum, which is phylogenetically removed from the body. If the testicle is located in the abdominal cavity, then it can not normally pass through the processes of spermatogenesis, which threatens a man with the development of infertility.

In addition to the fact that the childbearing function suffers, hormonal is gradually disrupted. Insufficient amounts of androgens, which are not able to develop in the testicle, which is in the abdominal cavity, leads to an inadequate development of secondary sexual characteristics. These boys do not have a mustache and beard, their body resembles a female constitution, and with age, and at all, impotence develops.

In addition, during incomplete lowering of the testicle, the inguinal gates are not completely closed, which leads to inguinal hernia. Over time, it can be affected, which will require urgent surgery, during which not only herniation can be performed, but also the amputation of the testicle itself.

Long-term studies have shown that an egg that is outside the scrotum has a very high risk of malignancy. Malignant neoplasms of this organ in the case of cryptorchidism occur 35 times more often than in the normal location of the testicle. The tumor that develops in this case is called seminoma and acquires a very aggressive course.

Also, if the position is wrong, the organ's injury or its wrench can often occur. Both the first and second can have the most terrible consequences, which can result in an operation to amputate the testicle.

As already mentioned, during the abdominal location of the testicle, the hematotestick barrier can be broken, and a huge amount of antibodies are produced in the human blood that are aggressive in relation to both the patient and the healthy testicle. As a result, both organs can be rejected.

Prevention of cryptorchidism

If the treatment of cryptorchidism is better for newborn children, then the issue of prevention should concern their mothers, since the disease is purely congenital and depends on the effect of unfavorable factors on the organism of the pregnant woman.

Particular care must be taken during the first months of pregnancy, as it is during this period that all the organs of the unborn child are laid. A variety of pathological agents affecting the pregnant woman in this period can cause cryptorchidism in the child.

To avoid this, it is necessary to plan very carefully the pregnancy and future birth. Experts recommend before conception to treat all chronic infections in the body and get rid of possible viral diseases. Also, modern medical equipment allows you to conduct medical genetic counseling, as a result of which you can find out the probability of a child having a genetic defect.

In addition, during pregnancy, avoid contact with any possible chemical agents. Especially often this happens during repairs or work in hazardous enterprises.

Also, care should be taken when taking medication during pregnancy. Among the total amount of teratogenic drugs, particular attention is paid to a group of non-steroidal anti-inflammatory drugs. Clinical studies have been able to identify a direct link between the use of paracetamol and the onset of cryptorchidism in a newborn. That is why during pregnancy, NSAIDs are being substituted for any other painkillers.

Rev.doctor urologist Astashin Е.Е.