The formation of cryptorchidism
Cryptorchidism: refers to the absence of testicles in the scrotum. Cryptorchidism is not a single course of disease under one pathogenesis, but a sum of a group of clinical abnormalities caused by multiple etiologies that are said to be familiar. So far, the pathogenesis of cryptorchidism is still under research, and its possible pathogenesis includes: abnormal development of the testicular lead; abnormal inguinal development and abnormal sphincter duct; abnormal attachment of the epididymis; endocrine abnormalities; and abnormal development of the testis itself.
Clinical symptoms of cryptorchidism
The scrotum of children with cryptorchidism is small on one side or both sides, and there is no testicle in the scrotum on palpation, and testicular-like objects can often be found in the inguinal region.
Dangers of cryptorchidism
Cryptorchidism has 4 major dangers.
1.Cancer: The relative risk of germ cell tumor in cryptorchidism patients is about 40 times of normal people; the age of cryptorchidism treatment is positively correlated with the relative risk of malignant change of testis; the higher the position of undescended testis, the greater the risk of malignant change.
2.Infertility: Testicular histological results are poor in older patients; 50% of semen analysis is abnormal in unilateral cryptorchidism and 75% of semen analysis is abnormal in bilateral cryptorchidism.
Testicular torsion: Due to the anatomical abnormality between cryptorchid and its tract, it is more likely to be torsioned and damaged.
4.Testicular injury: Since the cryptorchid is located in the inguinal canal or near the pubic nodes, it is relatively superficial and fixed, without the cushioning protection of the normal testicular scrotum.
5.Other: certain psychological influence, combined syringomyelia canal abnormality (hernia/syringomyelia).
Treatment of cryptorchidism
1. <6< span="">months: observation is the main focus. Approximately 70% to 77% of cryptorchidism usually descends spontaneously to the testis within 3 months after birth, but the chance of continued descent decreases significantly by 6 months of age.
2.6～12 months：Continued observation or active surgery or hormone therapy can be considered for children with bilateral problems. The basis of hormone therapy is to produce more testosterone in the body by stimulating different levels of the hypothalamic-pituitary-gonadal axis. Types of drugs: GnRH/LHRH; hCG.
Side effects of hormone therapy: increased scrotal folds and hyperpigmentation, growth of external genitalia; some may have mental changes or significant weight gain; longer time or high dose of hCG may cause early epiphyseal healing.
3. 12 months to 18 months: Active surgical treatment.
Complications after cryptorchidism surgery
1.Decide the operation mode according to the intraoperative situation, and do not exclude the possibility of doing staged operation or laparoscopic Fowler Stephen operation.
2. The purpose of surgery is to improve the testicular growth and development environment and to prevent testicular malignancy. For the damage that already exists in the testicle cannot be repaired, there is still a risk of distant testicular tumor occurrence and there is still a risk of infertility.
3. unsatisfactory testicular descent position, unable to descend to the bottom of the scrotum possibly, possibly due to testicular atrophy, unable to explore the testicle; possibly due to extremely poor testicular development, to the stunted testicle removal.
4. postoperative testicular atrophy and shrinkage; retraction of testicular position
5.Intraoperative and postoperative bleeding, infection, and postoperative scrotal swelling.
Which children should undergo cryptorchidism surgery
According to the basic medical viewpoint, in principle, as long as the diagnosis is clear, children with cryptorchidism aged ≥6 months can be treated with cryptorchidism surgery.
Key points of postoperative care for cryptorchidism
1.Posture and activity: After surgery, the child should lie flat with the pillow removed for 6 hours. Because the respiratory secretions increase under anesthesia and the muscles relax, it is easy to cause vomiting and mis-aspiration. If there is vomiting, please remove the vomit in time and change clean clothes and pants, and pay attention to the color of the child’s mouth and lips, if there is cyanosis, phlegm in the throat and breathing difficulty, you need to notify the doctor or nurse immediately. After the operation, the nurse will routinely place your child on cardiac monitoring and oxygen for 6 hours, please be careful not to let your child grab and pull the tube.
2.Wound care: if there is a small amount of blood oozing from the wound, it is normal and does not need to be treated. If the blood oozing is bright red and the area is wetting the whole layer of gauze, please inform the doctor in time; usually a transparent waterproof dressing is put on the outer layer of the wound, pay attention to prevent urine from wetting the wound, keep the bed clean and dry, and change the diaper in time. The wound dressing in the groin area is removed 7 days after surgery, and the sutures and dressing in the scrotum are removed 12 days after surgery. After removing the dressing, if the wound heals well, you can take a bath.
3, diet: no water and food before anesthesia awake, 2 hours after surgery can enter a little plain water water, if there is no nausea, vomiting and other discomfort can be light and easy to digest food, such as thin rice, milk, noodles, cakes, etc., the first day after surgery to resume normal diet. Encourage the child to drink more water, eat more coarse fiber food, and keep the bowel movement smooth.