When the descending process of the testicle is obstructed and the testicle stays in the middle of the descending pathway, it becomes cryptorchidism, also known as undescended testicle.
Since the proximal end of the peritoneal sheath is occluded and the distal end is open to form the testicular sheath after the normal descent of the testis, most of the people with undescended testis are accompanied by congenital inguinal hernia. The incidence of cryptorchidism is high. Generally speaking, the undescended testis of cryptorchidism located in the inguinal region accounts for about 70%, the latter located in the abdominal cavity or peritoneum accounts for about 25%, and the rest often stay in the perineum, upper scrotum or other parts. The incidence of left and right is similar, and the unilateral incidence is higher than bilateral. The etiology of cryptorchidism has not yet been elucidated, and there are many related theories, mainly the following two views: Pediatric surgery motor of Dongguan Eighth People’s Hospital
The first view is anatomical factors: including: 1. the testicular tract is too short, which does not allow the testis to descend sufficiently; 2. adhesions occur between the testicular tract and the peritoneum; 3. abnormal development of the testicular vessels or the presence of folds, which restrict the descent of the testis by pulling from above; 4. the spermatic vessels or vas deferens are too short; 5. the diameter of the testis and epididymis is larger than the diameter of the inguinal canal, so that they cannot pass; 6. the testis fuses and becomes too large and unable to descend; 7. The testicular lead band is absent, too short or fixed; 8. Excessive activity of the levator muscle hinders the descent of the testis; 9. The inguinal canal is so poorly developed that it cannot allow the testis to pass; 10. The scrotum is poorly developed and lacks a cavity to accommodate the testis.
The second view is endocrine factors: testicular descent requires adequate amounts of sex hormone stimulation, especially gonadotropins from the mother. During the last 2 weeks of gestation, maternal gonadotropins are released in large amounts, and the fetal testes descend accordingly. However, the lack of maternal gonadotropins causing bilateral cryptorchidism can be explained, but the induction of unilateral cryptorchidism is generally not understood. On the other hand, the testes themselves are not sensitive to gonadotropin stimulation due to poor development, and the testosterone production in the testes themselves is also impaired or disturbed, which can also lead to cryptorchidism, and this idea can quite explain the occurrence of unilateral cryptorchidism.
In cryptorchidism, the testicles cannot be felt in the scrotum of the affected area. Some other conditions may also occur as follows.
1. The testicles are located in the inguinal region, which is more superficial and easily subjected to trauma such as squeezing and collision.
2.Cryptorchidism is often accompanied by inguinal hernia, once the hernia is embedded, severe pain can occur, and affect the blood flow of the testicles, affecting the function of the testicles.
3.Cryptorchidism is prone to torsion, acute pain and testicular necrosis if treatment is not timely.
4.The cryptorchid is far away from the scrotum and is at 37℃ body temperature, while spermatogenesis needs a scrotal environment of 35~36℃, which obviously affects spermatogenesis.
5.Cryptorchidism is prone to malignant change.
6.Since cryptorchidism causes abnormal scrotal morphology and testicular dysfunction, it sometimes causes changes in the mental and psychological state of the patient.
The diagnosis of cryptorchidism is not difficult, and a general physical examination can reveal the lack of testicles in the scrotum, while most of them can be felt in the inguinal region or above the scrotum. However, for cryptorchidism that cannot be felt in the abdominal cavity or retroperitoneum, it cannot be found by regular physical examination, and some special examinations are needed to locate it. Some of the methods currently applied are as follows.
1.Transfemoral testicular vein imaging method, injecting the contrast agent into the femoral vein and observing where the testicular vein plexus-like manifestation appears along the vein shown by the contrast agent, that place may be cryptorchid.
2.Computerized X-ray tomography (CT) scan The advanced CT technology can detect cryptorchidism by scanning the descending path of the testicles.
3.Ultrasonic examination detects the descending pathway of the testis.
In addition, testicular arteriography and laparoscopy can be used to locate it.
If both testes cannot be felt, endocrine tests can be done before the above localization tests are performed.
【Treatment】
There are two main types of treatment for cryptorchidism.
Cryptorchidism, also known as undescended testes, occurs when the descent process of the testes is obstructed and the testes stay in the middle of the descent pathway.
Since the proximal end of the peritoneal sheath is occluded and the distal end is open after the normal descent of the testicle, forming the testicular sheath, most of the people with incomplete testicular descent are accompanied by congenital inguinal hernia. The incidence of cryptorchidism is high. Generally speaking, the undescended testis of cryptorchidism located in the inguinal region accounts for about 70%, the latter located in the abdominal cavity or peritoneum accounts for about 25%, and the rest often stay in the perineum, upper scrotum or other parts. The incidence of left and right is similar, and the unilateral incidence is higher than bilateral. The etiology of cryptorchidism has not yet been elucidated, and there are many related theories, mainly the following two views: Pediatric surgery motor of Dongguan Eighth People’s Hospital
The first view is anatomical factors: including: 1. the testicular tract is too short, which does not allow the testis to descend sufficiently; 2. adhesions occur between the testicular tract and the peritoneum; 3. abnormal development of the testicular vessels or the presence of folds, which restrict the descent of the testis by pulling from above; 4. the spermatic vessels or vas deferens are too short; 5. the diameter of the testis and epididymis is larger than the diameter of the inguinal canal, so that they cannot pass; 6. the testis fuses and becomes too large and unable to descend; 7. The testicular lead band is absent, too short or fixed; 8. Excessive activity of the levator muscle prevents the testicle from descending; 9. The inguinal canal is poorly developed and does not allow the testicle to pass; 10. The scrotum is poorly developed and lacks a cavity to accommodate the testicle.
The second view is endocrine factors: testicular descent requires adequate amounts of sex hormone stimulation, especially gonadotropins from the mother. During the last 2 weeks of gestation, maternal gonadotropins are released in large amounts, and the fetal testes descend accordingly. However, the lack of maternal gonadotropins causing bilateral cryptorchidism can be explained, but the induction of unilateral cryptorchidism is generally not understood. On the other hand, the testes themselves are not sensitive to gonadotropin stimulation due to poor development, and the testosterone production in the testes themselves is also impaired or disturbed, which can also lead to cryptorchidism, and this idea can quite explain the occurrence of unilateral cryptorchidism.
In cryptorchidism, the testicles cannot be felt in the scrotum of the affected area. Some other conditions may also occur as follows.
1. The testicles are located in the inguinal region, which is more superficial and easily subjected to trauma such as squeezing and collision.
2.Cryptorchidism is often accompanied by inguinal hernia, once the hernia is embedded, severe pain can occur, and affect the blood flow of the testicles, affecting the function of the testicles.
3.Cryptorchidism is prone to torsion, acute pain and testicular necrosis if treatment is not timely.
4.The cryptorchid is far away from the scrotum and is at 37℃ body temperature, while spermatogenesis needs a scrotal environment of 35~36℃, which obviously affects spermatogenesis.
5.Cryptorchidism is prone to malignant change.
6.Since cryptorchidism causes abnormal scrotal morphology and testicular dysfunction, it sometimes causes changes in the mental and psychological state of the patient.
The diagnosis of cryptorchidism is not difficult, and a general physical examination can reveal the lack of testicles in the scrotum, while most of them can be felt in the inguinal region or above the scrotum. However, for cryptorchidism that cannot be felt in the abdominal cavity or retroperitoneum, it cannot be found by regular physical examination, and some special examinations are needed to locate it. Some of the methods currently applied are as follows.
1.Transfemoral testicular vein imaging method, injecting the contrast agent into the femoral vein and observing where the testicular vein plexus-like manifestation appears along the vein shown by the contrast agent, that place may be cryptorchid.
2.Computerized X-ray tomography (CT) scan The advanced CT technology can detect cryptorchidism by scanning the descending path of the testicles.
3.Ultrasonic examination detects the descending pathway of the testis.
In addition, testicular arteriography and laparoscopy can be used to locate it.
If both testes cannot be felt, endocrine tests can be done before the above localization tests are performed.
【Treatment】
There are two main types of treatment methods for cryptorchidism.
1. Endocrine treatment can be applied in the short term with high-dose hCG shock treatment, 5000iu per time, im, qod, and the total amount can be more than 30,000iu; or stimulation treatment with small-dose hCG, 1000iu per time, im, qd, for 2 weeks. If no trend of testicular descent is seen after medication, then surgical treatment should be used instead. However, there are now a large number of reports that the difference between using hormones and not using hormones is not significant, and it may also bring many side effects.
2.Surgical treatment If endocrine treatment does not work, surgery should be performed in time. There are three methods: the first is testicular descent fixation, the second is testicular autotransplantation (because the testicle is too high), and the third is orchiectomy (because the testicle is too poorly developed).
3.Nowadays, the common view is that cryptorchidism should be operated before 2 years old, but experimental studies believe that 70% of the testes of children with cryptorchidism are already degenerated by one year old. Clinical observation concludes that after 6 months of life, if the testicle still has not descended to the scrotum, there is very little chance for it to descend on its own. Therefore, we advocate that children with cryptorchidism should be operated at the age of 1 year to ensure the function of cryptorchidism to the maximum extent.
Endocrine treatment can be applied in the short term with high-dose hCG shock treatment, 5000iu per time, im, qod, and the total amount can be more than 30,000iu; or stimulation treatment with small-dose hCG, 1000iu per time, im, qd, for 2 weeks. If no trend of testicular decline is seen after medication, then surgical treatment should be used instead. However, there are now a large number of reports that the difference between using hormones and not using hormones is not significant, and it may also bring many side effects.
2.Surgical treatment If endocrine treatment does not work, surgery should be performed in time. There are three methods: the first is testicular descending fixation, the second is testicular autotransplantation (because the testicle is too high), and the third is orchiectomy (because the testicle is too poorly developed).
3.Nowadays, the common view is that cryptorchidism should be operated before 2 years old, but experimental studies believe that 70% of the testes of children with cryptorchidism are already degenerated by one year old. Clinical observation concludes that after 6 months of life, if the testicle still has not descended to the scrotum, there is very little chance for it to descend on its own. Therefore, we advocate that children with cryptorchidism should strive for surgery around 1 year old to ensure the function of cryptorchidism to the maximum extent.