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 testis descends normally, most of the people with undescended testis have 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 been elucidated, and there are many related theories, mainly two views as follows.
The first view is anatomical factors: including.
(1) The testicular tract is too short and does not allow the testicle to descend sufficiently;
(2) Adhesions between the testicular tract and the peritoneum;
(3) abnormal development of testicular vessels or the presence of folds that restrict the descent of the testis by pulling from above;
④Vessels of the spermatic cord or vas deferens are too short;
(5) The diameter of the testes and epididymis is larger than the diameter of the inguinal canal, so that they cannot pass;
(6) The testis is fused and becomes too large to descend;
(7) The testicular lead is absent, too short or fixed;
(viii) Excessive activity of the levator muscle preventing the descent of the testis;
(⑨) Dysplasia of the inguinal canal, which does not allow the testis to pass;
The scrotum is underdeveloped and lacks a cavity to accommodate the testes.
The second view is that of 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, and once the hernia is ingrown, severe pain can occur.
3.The cryptorchid is prone to torsion and acute pain will occur.
4.The cryptorchid is far away from the scrotum and is at a body temperature of 37℃, while spermogenesis needs a scrotal environment of 35~36℃, which obviously affects sperm generation.
5.Cryptorchidism is prone to malignant change.
6.Since cryptorchidism causes abnormal scrotal morphology and testicular dysfunction, it sometimes causes changes in the patient’s mental and psychological state.
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.
Currently, the following methods are applied.
1.Transfemoral testicular vein imaging method, injecting 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 testis.
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 testing can be done before the above localization tests are performed.
Treatment
Cryptorchidism treatment is quite ideal when surgery is performed around 2 years old. There are two main types of treatment methods.
1, endocrine treatment can be applied in the short term with high-dose hCG shock treatment, 5000iu per time, im, qod, total up to 30,000iu or more; 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.
2.Surgical treatment If endocrine treatment does not work, surgery should be performed in time. There are three methods: the first one is testicular fixation, the second one is testicular autotransplantation, and the third one is orchiectomy.
The relationship between cryptorchidism treatment and testicular tumor incidence was found to be not much related to the incidence of testicular cancer and whether cryptorchidism is treated timely or not, and the prognosis of testicular cancer in cryptorchidism patients is not determined by whether cryptorchidism is corrected or not, but directly related to the stage and treatment method of testicular cancer. Even if a patient with cryptorchidism has undergone surgery, there is still a possibility of malignant transformation, which should be alerted.