Cryptorchidism: do not miss the best opportunity for treatment
Some parents, while bathing their children, inadvertently find that the scrotum on both sides of the child is not the same size. On the one hand, the scrotum is fuller, and on the other hand, it is hollow. On touching again, they find that there are no testicles inside. Then they go to the hospital to have an examination. I’m having surgery.
Men have two testicles and a penis, and that’s what everyone knows, but you know what? Some men are born with their testicles not in the scrotum, but in the groin or deeper.
The disease, called cryptorchidism, can be treated surgically.
The process of testicular development and cryptorchidism.
What is cryptorchidism? Why would a child have a cryptorchidism? This is the first reaction that many parents have when they hear about the disease.
In fact, in the early stages of the fetus, the testicles are not in the scrotum, but in the belly, behind the peritoneum, like the kidneys, and as the fetus develops, the testes will gradually descend along the peritoneum, toward the groin, and then toward the scrotum, until the time of birth. Most of the children’s testicles fell into the scrotum.
But there is a small number of children did not complete this process, the testes stay in the abdominal cavity, groin, leading to cryptorchidism.
Cryptorchidism can be unilateral, it can also be bilateral, but not all scrotum empty is cryptorchidism, sometimes Creator muscle is more active can pull testis to scrotum top or groin area, scrotum also can empty flatten, that does not have very big problem necessarily. But you have to check with a doctor before you know for sure.
In addition, some children are born without a testicle, or the testicle ran to the opposite side of the scrotum to go, showing that the scrotum is hollow, these are other special types of cryptorchidism, is also in need of treatment.
The incidence of cryptorchidism is actually quite high, with the number of full-term boys at birth reaching 3.4% to 5.8%. Fortunately, many children can continue to complete this decline after birth, by the time they reach the age of half. About 0.8 percent have cryptorchidism, and for premature babies, This can be as high as 10 per cent.
As the age increases, the ability of the testis to continue to decline on its own becomes weaker and weaker. It is generally believed that the decline occurs mainly in the first three months of life, and if the testicles do not reach the scrotum by the fourth month, treatment will be required.
So why can’t some kids’ testicles descend into the scrotum?
There are a lot of theories, such as the premature birth of a child, and this decline has not yet been completed, which is why the incidence of cryptorchidism in children born prematurely is so high. Another example of the mother pregnant age, too fat, endocrine problems and so on, it is interesting that some studies also believe that even during pregnancy drink too much cola may also lead to children cryptorchidism.
Experiments have shown that testicular decline is associated with many hormones, and if the mother’s hormone levels are abnormal, it can lead to abnormal testicular decline in the child. These are possible causes, and it is difficult to determine exactly what causes a child’s cryptorchidism.
The harm of cryptorchidism.
The testicles, the sperm factories, require a very high temperature, 1.5 to 2 degrees below the body’s body temperature, which the scrotum can provide.
Once the testicles do not normally descend into the scrotum and remain in the abdominal cavity and groin which are hotter than the scrotum, the testes will not develop and work properly. Over time, the testes will slowly degenerate or even atrophy, leading to later infertility. It can even cause testicular cancer.
In addition, cryptorchidism children are often combined with hernia, once intestinal canal pressure more likely to lead to testicular and intestinal necrosis, testicular stay in the groin is also more prone to torsion, resulting in necrosis, these are the main hazards of cryptorchidism.
In addition, because the scrotum of cryptorchidism child is hollow, the child feels him to differ with other child, also can cause psychological shadow.
Drug treatment of cryptorchidism.
It is precisely because of these hazards, so the diagnosis of cryptorchidism clear, once the testicle can fall beyond the age of their own, it should be treated.
Treatment of cryptorchidism includes drug therapy and surgery.
Hormone therapy of cryptorchidism has a long history, especially in Europe, but is still controversial, because most studies believe that it has no significant effect on testicular decline, and has the side effects of scrotal penile enlargement, testicular enlargement, penile erectile and other side effects. Although the withdrawal of drugs can also subside. However, some studies suggest that hormones can increase the number of spermatogenic cells, improve the pathological damage of the testis.
Surgical treatment of cryptorchidism.
The vast majority of cryptorchidism children still need surgery, surgery is mainly to find the testicles, release it after pulling into the scrotum and fixed, so that it in the right environment for development, the vast majority of cryptorchidism can also be resolved through surgery.
It used to be thought that surgery should be performed before the age of two, because it was thought that irreversible testicular damage would occur after the age of two, and the treatment would be much less effective. Recent studies have found that pathological changes occur in the testicles between June and December, so the age at which surgery is recommended is being advanced.
At present, the world generally recommends no later than 9-15 months, but some people think that 6 months is the best time.
Minimally invasive surgery is widely used in the treatment of a variety of diseases, including cryptorchidism, for very high position of cryptorchidism, especially the kind of testes that can not be touched, laparoscopy has a great advantage.
However laparoscopic surgery is not suitable for all cryptorchidism patients. For cryptorchidism with low position laparoscopic surgery will not bring convenience but may increase the difficulty of surgery and aggravate the injury. The doctor should choose the most appropriate method according to the specific situation of each patient. The right method is the best one.
Surgery can create a suitable environment for the development of the testes, but can not reverse all the testicular damage, some children after surgery, the affected side of the testes will be smaller than the normal side.
And even if had the operation, also cannot guarantee later the birth is completely normal.
According to statistics, the normal male infertility rate is 6%, unilateral cryptorchidism infertility rate is about 10.5%, and bilateral cryptorchidism can reach 38%.
Cryptorchidism long-term chance of testicular malignant tumor is also much higher than the normal population, there are people who believe that cryptorchidism surgery can not reduce the risk of testicular malignant change. So, especially after puberty, cryptorchidism children should learn to self-testicular examination.
These conclusions, of course, are drawn from previous patients, and may change with the timing of treatment. With the development of assisted reproductive technology, infertility may gradually improve.