Cryptorchidism is a common congenital genitourinary abnormality in which the testes fail to descend from the lumbar retroperitoneum to the base of the scrotum according to the normal developmental process and remain in the abdominal cavity, inguinal region, scrotal inlet, or other sites. Cryptorchidism includes: incomplete testicular descent; testicular ectopia; and testicular agenesis.
[Etiology and pathogenesis
Although cryptorchidism is common, the research on its etiology is not deep enough. At present, it is thought that it may be related to endocrine disorders, defects in the development of the testis itself or the epididymis, or some mechanical disorders in the descent pathway of the testis.
Diagnosis
I. Symptoms
Most of the children have no conscious symptoms, mainly manifesting as scrotal dysplasia on the affected side, and the scrotum is empty without testicles.
2. Physical signs
The scrotum on the side of cryptorchidism is flat, and the scrotum is poorly developed in bilateral cases.
2.There is no testicle in the scrotal emptiness on palpation; about 80% of the testicles can be found in the inguinal region, but the volume is generally smaller than that of the opposite side, and cannot be pushed into the scrotum, and there is a feeling of swelling and pain when squeezed.
3.After descending through the inguinal canal, the testicle leaves the normal path and stays in the shallow subcutaneous part of the inguinal canal, above the thigh, perineum or penile root and other abnormal parts is called testicular ectopic.
III. Laboratory examination
1.B ultrasound or CT, MRI Localization of the untouched testis, but the examination results are not exact.
2.Laparoscopy is used for examination of untouched testicles, and the diagnostic accuracy rate is over 95%.
3. Hormone test The chorionic gonadotropin hormone (HCG) test is mainly used for testes that cannot be palpated bilaterally. The basal value of plasma testosterone, FSH and LH are measured first, and testosterone is rechecked after HCG injection, if the concentration increases, it indicates the presence of functional testes, and then localization test is performed.
Differential diagnosis
1. Retractable testis: The testis stays above the scrotum or in the inguinal canal for a certain period of time due to excessive contraction of the levator muscle, and during physical examination, the testis can be gently pushed downward to the scrotum and stays there for a few moments as a retractable testis. Usually no treatment is needed and the testicle can descend into the scrotum on its own until puberty and no longer retract.
2.Sliding testicle: If the testicle can be pushed into the scrotum by pushing the testicle in the groin, and then retracted to the groin after releasing the testicle, it is called sliding testicle and belongs to cryptorchidism.
Treatment
I. Hormone treatment
If the testis is still cryptorchid 10 months after birth, hormone therapy should be started, the purpose is to promote testicular development and descent.
1.HCG therapy The dose is 500-1000IU according to age and body weight, injected intramuscularly twice a week for a total of 10 times, and the total amount is 5000-10000IU.
2.LHRH therapy Luteinizing hormone-releasing hormone (LHRH) or gonadotropin (GNRH) is administered by nasal mucosal spray. The dose is 1 or 2mg/d, which can be divided into 3 times and used for 4 weeks.
Second, surgical treatment
1. Testicular fixation Surgery can be performed before the age of about 1 year and 2 years, using the external fixation method of the sarcoid capsule.
2. For testes with high position such as short spermatic cord, which cannot be fixed at the bottom of scrotum in one phase, available: staged testicular fixation; testicular autotransplantation; Fowler-Stephen surgery to retain the lead, vas deferens blood flow and cut off the spermatic cord.
3. For cryptorchid cases where the testes cannot be palpated, laparoscopic diagnosis and treatment should be applied.