Knowledge about cryptorchidism
1. The cause of cryptorchidism is not known
2. l0% of testicular descent occurs at 24 weeks of gestation, 50% at 27 weeks, 75% at 28 weeks, and 80% from the 34th week of gestation to the time of birth.
3. 3% of full-term male infants can develop cryptorchidism, and about 70%-77% of cryptorchidism usually descends spontaneously into the scrotum within the first 3 months of life.
4. Birth weight is the primary determinant of cryptorchidism in newborns and 1-year-old infants, independent of the length of gestation.
5. 80% of cryptorchid testes are palpable and 20% are not. The ectopic undescended testis is most often located in the superficial inguinal fossa.
6. Children with retractable testes must be followed annually until puberty or until the testes no longer retract. The pathology of sliding testicular germ cells is abnormal and resembles that of a primary undescended testis.
7. Up to 90% of patients with cryptorchidism have associated epididymal abnormalities.
Complications of cryptorchidism
1. Testicular dysfunction Decreased fertility or infertility in adulthood
2.Cryptorchidism with unclosed sphincter.
3. Testicular injury, cryptorchid torsion.
4.Cryptorchid malignancy The incidence of cryptorchid malignancy in adults is 35-48 times higher than that in normal people. Early surgery can’t reduce the chance of malignancy, but it can help to detect abnormalities at an early stage.
Treatment of cryptorchidism
Treatment principles
1. Correct judgment of anatomical relationship, position and vitality of undescended testis.
2.Judgment of the possibility of co-morbidities of other related syndromes.
3.Fix the testis in the scrotum in time. Prevent further impairment of testicular fertility or endocrine function.
4.Fix the testis permanently in a normal position within the scrotum and make it easy to palpate.
5.Treatment does not cause further damage to the testicle.
Treatment purpose
1.Improve the appearance of the scrotum so that the obvious defects can be corrected.
2.To avoid psychological and mental trauma in children.
3.The malignant tendency can be detected in time.
4.Improve the fertility.
Treatment of cryptorchidism: Key points
1. For cryptorchidism, imaging examination cannot play a key role, nor can it determine the surgical treatment.
2. When bilateral non-palpable cryptorchidism appears in newborns, the presence or absence of testes should be carefully determined and the condition of hermaphroditism should be excluded.
3. Surgical treatment of undescended testes should be performed between 6 and 12 months of age.
4. The effectiveness of hormonal treatment is less than 20% and significantly correlates with the position of the undescended testis before treatment.
5. 20% of cryptorchidism are non-palpable testes, and about 50% of this group of patients are monorchidic.
6. 13% of testicular appendages/tubercles are viable and should be removed.
Routine surgical methods for cryptorchidism
The following is the surgery of bilateral cryptorchidism in our hospital, the incision and trauma are very small, and the patient can be discharged 1-2 days after surgery
Laparoscopic treatment of cryptorchidism, diagnosis of non-palpable cryptorchidism and evaluation of cryptorchidism.
The advantage of laparoscopic technique is that it can more precisely identify the anatomical location and viability of the untouchable testis and, if necessary, use the best access to solve surgical problems.
There are usually four separate scenarios for laparoscopic exploration of an inaccessible testis and their respective management:
1, blind end of the testicular vascular system (disappearing testis) above the opening of the internal ring.
2, Spermatic structures entering the internal ring orifice (viable inguinal canal testes, as opposed to inguinal canal, atrophied testes in the scrotum).
3, Intra-abdominal testis.
4, Testicular dysplasia.
Laparoscopic testicular fixation
Laparoscopic testicular fixation is nowadays the standard procedure for the management of intra-abdominal testis. In the management of intra-abdominal cryptorchidism, laparoscopic testicular fixation is superior to standard testicular fixation performed through an extended inguinal incision or a high inguinal incision (Jones incision), which allows a more accurate determination of the presence or absence of intra-abdominal testes, their viability, overall anatomical relationships, etc. Successful freeing of the testis requires complete and proximal cutting of the spermatic cord and then finding the shortest “descending” path to the scrotum. “descent” path to the scrotum. The magnifying effect of the laparoscope on these fine vessels helps to ligate and protect a good blood supply to the trunk and lateral branches.
Complications of testicular fixation
Complications include testicular regression, hematoma, skeletal inguinal nerve injury, postoperative testicular torsion (medically or spontaneously), vas deferens injury, and testicular atrophy. Testicular atrophy is the most serious complication, but is rarely seen with standard testicular fixation. Interruption of blood supply accompanying testicular atrophy can be caused by spermatic cord fibrosis, excessive electrocoagulation, inadvertent spermatic cord vessel torsion during descent, and ligation and dissection of the spermatic cord vessels during Fowler-Stephen testicular fixation. It can also be caused by excessive axial tension in the spermatic cord, especially in the presence of poor collateral circulation. Some degree of postoperative hematoma is common, but large hematomas predispose to infection and abscess formation. Regression is caused by inadequate retroperitoneal debridement, and inadequate spermatic cord length will, regardless of the amount of tissue dissected, lead to failure of the fixation. If the unclosed sphincter is ligated in the inguinal canal rather than above the internal ring opening, the peritoneal residue will adhere to the spermatic cord and will result in less easy access for complete retroperitoneal vascularization.
The above is some introduction to the treatment of cryptorchidism in our hospital, and we hope it will be helpful to the families of children with the disease.