When some parents give their children a bath, they unintentionally find that the two sides of their scrotum are different in size, one side is fuller and the other side is more empty and deflated, and then when they feel it, they find that there are no balls inside, and then they go to the hospital for examination, and the doctor says it is cryptorchidism and they need to do surgery.
Testicular development process and cryptorchidism
What is cryptorchidism? Why does a child have cryptorchidism? This is the first reaction of many parents when they hear about this disease. In fact, in the early fetal stage, the balls are not in the scrotum but in the stomach, just like the kidneys, they are behind the peritoneum. As the fetus develops, the balls will gradually descend along the back of the peritoneum towards the groin and then towards the scrotum, and at birth, most children’s balls descend into the scrotum, but a small number of children do not complete this process, and the balls stay in the abdominal cavity and in the groin, which leads to cryptorchidism.
Sometimes the testicles are pulled to the top of the scrotum or inguinal area by the active testicular muscle, and the scrotum will also be empty, that doesn’t necessarily mean there is a big problem, but it must be checked by a doctor to be sure. There are also children who are born with one testicle missing or the testicle goes to the opposite side of the scrotum and shows up as an empty scrotum, these are other special types of cryptorchidism and also need treatment.
The incidence of cryptorchidism is actually quite high, up to 3.4%-5.8% in newborn full-term male babies. The good thing is that many children can continue to complete this descent process after birth, and by the time they are half a year old, about 0.8% of them still have cryptorchidism, while the figure can reach 10% in premature babies. As children grow older, the ability of the testes to continue to descend on their own becomes weaker and weaker. It is generally believed that the descent occurs mainly within the first three months of life, and by the time the testes have not descended by four months, they will not be able to descend.
So why do some children’s testicles not come down? There are a lot of arguments, for example, the child was born prematurely and the descent process was not completed yet, which is why the incidence of cryptorchidism is high in children born prematurely, for example, the mother is too old when pregnant, too fat, endocrine problems, etc. Interestingly, some studies also believe that even drinking too much cola during pregnancy may lead to cryptorchidism in children. Experiments have confirmed that the descent of the testicles is related to many hormones, and if the hormone level in the mother’s body is abnormal, it may lead to abnormal descent of the testicles in the child. These are the possible causes, and it is difficult to determine exactly what causes cryptorchidism in any child.
Dangers of cryptorchidism
The testicles are the factory of sperm production and they require a high temperature. 1.5-2 degrees lower than the body temperature is the most suitable temperature for them, and the scrotum can provide just such a temperature. Once the testicles do not descend normally into the scrotum and stay in the abdominal cavity and groin where the temperature is higher than that of the scrotum, the testicles cannot develop and work normally, and in time they will slowly degenerate and even atrophy, leading to infertility and even testicular cancer in later stages. In addition, children with cryptorchidism are often combined with hernia, and once intestinal tube compression occurs, it is more likely to lead to necrosis of testicles and intestines, and testicles staying in the groin are also more likely to twist and lead to necrosis, which are the main hazards of cryptorchidism. In addition, because the scrotum of a child with cryptorchidism is empty and deflated, the child feels different from other children, which will also cause psychological shadows.
Medication for cryptorchidism
Because of these dangers, once the diagnosis of cryptorchidism is clear, it should be treated once the age of self-descension has passed. Hormone treatment for cryptorchidism includes both medication and surgery, mainly human chorionic gonadotropin (hCG), GnRH and LHRH. hormone treatment for cryptorchidism has a long history, especially in Europe, but it is still somewhat controversial because most studies believe that it is not effective for testicular descent and has side effects such as scrotal penis enlargement, testicular enlargement and penile erection, although it can subside after stopping the medication. However, there are some studies that suggest that the hormone may increase the number of spermatogenic cells and improve pathological damage to the testes.
Many doctors believe that hormones can be used in the following two situations.
I. When the testicles are positioned closer to the scrotum, and the diagnosis is not very clear in two cases of low cryptorchidism and testicular retraction, the testicles can descend into the scrotum by using hormone testicular retraction, which avoids mistaking the testicular retraction for cryptorchidism and performing surgery.
Second, for the kind of high cryptorchidism that cannot feel the testicles, it may be necessary to do the kind of surgery to cut off the blood vessels of the spermatic cord, which has a higher rate of testicular atrophy after the surgery, and after these patients use hormones, part of the testicles of these patients may be felt, which may avoid doing this kind of high-risk surgery; some people think that even if this kind of surgery really has to be done, the use of hormones can increase the blood supply to the testicles, which can reduce the rate of testicular atrophy after this kind of surgery. The rate of postoperative testicular atrophy.
The main treatment is surgery
However, most children with cryptorchidism still need surgery. The main purpose of surgery is to find the testicle, pull it loosely into the scrotum and fix it, so that it can develop in a suitable environment, and most cryptorchidism can be lowered through surgery.
In the past, it was thought that surgery should be performed before the age of 2 because it was believed that irreversible damage to the testicle would occur after the age of 2 and the treatment would be much less effective. In recent years, studies have found that pathological changes occur in the testicles between 6 and 12 months of age, so the recommended age for surgery is also being advanced. Foreign recommendations are no later than 9-15 months, and some believe that 6 months is the most appropriate. However, according to the national situation, most doctors in China recommend surgery around the age of 1 year, based on the convenience of anesthesia and surgery, but there is a tendency to advance it gradually.
Minimally invasive surgery is now widely used in the treatment of various diseases, including cryptorchidism. For cryptorchidism in a very high position, especially the kind of testicle that cannot be felt, laparoscopy has great advantages. However, laparoscopic surgery is not suitable for all patients with cryptorchidism. For cryptorchidism that is not in a high position, laparoscopic surgery will not bring convenience but may make the surgery more difficult and aggravate the injury. Doctors should choose the most suitable method according to each patient’s specific situation, and the right one is the best.
Surgery can create a suitable environment for the development of the testicles, but it cannot reverse all the damage to the testicles, and some children will still have a smaller testicle on the affected side than the normal one after surgery. Moreover, even after surgery, there is no guarantee that future fertility will be completely normal. According to statistics, the infertility rate of normal men is 6%, the infertility rate of unilateral cryptorchidism is about 10.5%, and the rate of bilateral cryptorchidism can reach 38%. The chance of testicular malignancy in the long term is also much higher than normal people, and some people think that cryptorchidism surgery cannot reduce the risk of testicular malignancy. Therefore, especially after puberty, children with cryptorchidism should learn to examine their own testicles.
Of course these conclusions are statistics from previous patients, and they may change as the treatment time is advanced. With the development of assisted reproduction technology, the infertility situation will probably improve gradually.
But in any case, early detection and not missing the best time for treatment is the key to improve the results of cryptorchidism surgery and reduce the long-term risk. All those who have a boy at home, it is better to touch his balls carefully.