Nowadays, there are more and more infertile couples, which brings a great threat to families; among them, male infertility accounts for a large proportion, and male infertility has attracted the attention of society. So what are the factors that can cause male infertility? Here we will introduce one of the culprits that trigger male infertility – cryptorchidism!
What is cryptorchidism?
1. Cryptorchidism refers to the testicle not descending to the scrotum, including incomplete testicular descent and testicular ectopic. Most of the cryptorchid testes are clinically incomplete. The ectopic testis is most often located in the superficial inguinal fossa. 80% of cryptorchid testes can be palpated, 20% cannot be palpated, about 20% of the non-palpable testes are testicular agenesis, and 30% are testicular atrophy. Children can retract their testes and usually only need follow-up to demonstrate that the testes are in a normal state and not retracted. The male karyotype must be confirmed when diagnosing bilateral anencephaly, and an endocrinological evaluation is necessary to help determine whether unilateral or bilateral testes are present.
2. Clinically, failure of the testes to descend into the scrotum is often referred to as cryptorchidism. Cryptorchidism is a condition in which the testicle leaves the normal descent pathway and reaches the perineum, femur, suprapubic area, or even the contralateral scrotum.
3. Under normal circumstances, as the fetus grows and develops, the testes begin to descend from the lumbar part of the retroperitoneum in the late stage of development within the subunit and descend into the scrotum in the late stage of fetal life, and if they are obstructed in the process of descent, cryptorchidism will be formed. Research results show that the incidence of cryptorchidism is 0.7 to 0.8%. The incidence is directly related to the development of the fetus.
About 3% of newborns have “cryptorchidism” and up to 30% of premature babies.
Most of the affected children descend into the scrotum within a few months or a year after birth under the effect of endocrine factors, and the incidence of cryptorchidism is 0.8% at the age of 1 year. Generally, medical treatment can be given and human chorionic gonadotropin can be applied to make the testes descend. If drug treatment is not effective, surgical treatment should be performed within 2 years of age.
What are the manifestations and consequences of cryptorchidism?
1. The manifestations of cryptorchidism.
(1) Commonly found in infants and young children, there are usually no obvious symptoms of cryptorchidism. If the inguinal hernia is caused by the unclosed sphincter, there may be a repeatable inguinal swelling.
(2) The scrotum on the affected side is flat, and bilateral cryptorchidism is often accompanied by scrotal hypoplasia, and the testicles cannot be touched in the scrotum, which is one of the more obvious symptoms of cryptorchidism.
(3) In some children, the testicles can be palpated at the groin.
(4) In case of concurrent incarcerated hernia or testicular torsion, acute pain and swelling in the scrotum or groin, etc. are the symptoms of cryptorchidism in pediatric scrotal emergencies.
2.Consequences of cryptorchidism.
(1) Produce psychological barriers: The absence of testicles in the scrotum and changes in the shape of external genitalia can make patients have low self-esteem and be reluctant to take a bath in public bathrooms, resulting in psychological abnormalities.
(2) Affecting sexual function: Since one testicle can still secrete sex hormones, it does not affect the sexual life of couples, but if both testicles do not descend into the scrotum, testicular development is hindered and sex hormones are not secreted enough, it may affect the sexual function in the future.
(3) Very easy to be malignant: Due to the change of growth environment and developmental disorders, cryptorchidism causes malignant transformation of testicular cells and forms malignant tumor, which is 35 times more likely to occur than normal testicles.
(4) Prone to injury: Since the testicles are hidden above and superficially located, they are prone to injury and pain when there is a slight impact or trauma.
(5) Causes male infertility: The temperature inside the scrotum is 1.5-2°C lower than the body temperature of 37°C. This “low temperature” condition is necessary for the testicles to produce sperm. Cryptorchidism does not have this “low temperature” condition, and the sperm production function is affected, thus causing male infertility.
Can surgery be done for cryptorchidism?
1.If the level of testosterone and luteinizing hormone in the serum of a patient with cryptorchidism is low and the serum testosterone rises after treatment with HCG, it indicates that the interstitial cells of the testis are sensitive to HCG and the testis has the greatest chance to fall.
2.Lumpectomy can diagnose inguinal canal and high intra-abdominal cryptorchidism with high accuracy. In recent years, it has been widely used in the diagnosis and treatment of cryptorchidism. Its operation method is simple and short, and it can be performed simultaneously with exploration and surgery. The laparoscopic procedure is usually performed in the hospital under general anesthesia. A small hole is cut in the patient’s belly button to allow for the insertion of a scope and the introduction of carbon dioxide. The carbon dioxide is used to dilate the abdominal cavity and open up the space for the doctor to operate, as well as to allow the doctor to carefully observe and treat the organ.
3. The new generation of laparoscopic therapy is the application of micro-tuboscopic technology to the exploration and treatment of cryptorchidism. The biggest advantage of laparoscopy is that it does not destroy the anatomical structure of the inguinal region and the levator muscle, and it can accurately locate the testicles or confirm the diagnosis of azoospermia, avoiding blind exploration, and it can also loosen the spermatic cord in the highest position and make it descend tension-free to the bottom of the scrotum for fixation, with little damage, quick recovery, short hospitalization time, 0.3-0.4cm wound and no scar, which is the best solution for the treatment of cryptorchidism at present.