Cryptorchidism symptoms. Cryptorchidism: symptoms, diagnosis and treatment of anomalies

Cryptorchidism is a congenital anomaly in which, by the time a boy is born and during the first 3 months of life, one or both testicles do not occupy their normal position in the scrotum. This developmental pathology is more typical for premature babies - in them it is recorded in 30% of cases. Among babies born on time and with normal weight, cryptorchidism is observed many times less often - on average, in only 3.5% of cases.

Note:the placement of the seminal gland in the scrotum, i.e. outside the abdominal cavity, is the most important factor in thermoregulation. Normal development of the testis and the subsequent formation of male germ cells is almost impossible at our usual body temperature. The difference between the temperature in the inguinal canal and the scrotum can reach 3°C. One of the oldest methods of male contraception is a hot bath (sauna). Even slight heating of the testicles significantly reduces the likelihood of conception.

During the first 6 months from birth, in 75% of boys with this congenital pathology, the testicles themselves occupy a normal anatomical position in the scrotum. Most experts associate this “self-healing” with a physiological increase in testosterone levels in the child. By the beginning of the second year of life, the anomaly is observed in only 1% of children. At later stages of development, the probability of prolapse of these organs of the reproductive system without medical intervention is close to zero.

During intrauterine development, the testes are first located retroperitoneally (next to the kidneys), and later - intraperitoneally, moving into the scrotum closer to the end of pregnancy.

Factors determining the movement of the testis into the scrotum:

• stretching the organ in the desired direction using Gunter's band;
• difference in the rate of development of the testis and cord;
• motility of the lower gastrointestinal tract;
• increased intra-abdominal pressure;
• development of the epididymis.

note:undescended testicles of the right testicle are recorded in 50%, of the left - in 20%, and of both - in 30% of diagnosed cases of cryptorchidism.

The process of testicular movement along the canal is largely influenced by hormones. These include the male luteinizing hormone, synthesized by the baby’s pituitary gland, as well as the gonadotropic hormones of his mother. Their deficiency is a common cause of cryptorchidism. Mechanical factors can also prevent the testicle from taking its place.

Important:very often (up to 95%) an undescended testicle is combined with congenital.

Classification

Cryptorchidism can be unilateral or bilateral.

It is customary to distinguish 2 main types of this pathology – retention and ectopia. Retention is also called true cryptorchidism.

Two main types of retention:

• intraperitoneal;
• inguinal

With intraperitoneal retention, the testes do not occupy their normal anatomical position, but “stop” without entering the canal. With inguinal retention, the testicles pass into the canal and are located at one of its levels, without descending into the scrotum.

Types of ectopia:

• superficial;
• femoral;
• penis-pubic;
• cross scrotal;
• perineal.

Ectopia is formed as a result of pathology in the development of the conductive ligament, which in this case is attached not inside the scrotum, but at another point. As a result, the cord directs the testis to the side, which causes an anomaly in the position of the organ.

With superficial ectopia, the testis is located under the skin above one of the abdominal muscles.

Femoral ectopia involves the placement of the testicle in the area of ​​the inner thigh.

With penopubic ectopia, the testicles lie on the pubic bone above the penis.

With the development of crossed scrotal ectopia, both testes pass through one inguinal canal, eventually descending into the right or left side of the scrotum.

Perineal ectopia is a type of anomaly in which the testis moves to the perineal area.

Important:even after successful surgery for testicular ectopia, most patients subsequently suffer.

Note:in the rarest cases, with diagnosed cryptorchidism, the testis and its appendage are connected by a cord, but are located at a certain distance from each other.

False cryptorchidism

Some boys have a high cremasteric reflex. It is characterized by the fact that the cremasteric muscle can pull the testicle from the scrotum in the opposite direction, i.e., into the inguinal canal. This phenomenon can occur, for example, with severe psycho-emotional or hypothermia. Most often this phenomenon is observed at 6-7 years of age. This deviation is not dangerous and does not require medical intervention; The testis can be brought down into the scrotum manually. When taking a warm shower or bath, the testes return to their normal position.

Reasons for the development of cryptorchidism

Among the factors leading to the development of pathology are:

• endocrine;
• mechanical;
• genetic.

Experts include endocrine causes:

• hormonal imbalance in the expectant mother (including disorders of the thyroid gland and pituitary gland;
• disturbances in the functional activity of the testicles in the unborn child.

Mechanical factors are:

• shortening of the spermatic cord;
• short blood vessels;
• narrowness of the inguinal canal;
• intraperitoneal adhesions;
• underdeveloped testicular ligaments.

Among genetic factors, the leading ones are:

• hereditary anomalies in the development of the anterior abdominal wall;
• Down syndrome;
• GTD gene mutation.

Important:in premature male newborns born weighing less than 910 g, cryptorchidism is observed in 100% of cases.

In rare cases, cryptorchidism may be acquired. In some cases, the cause of reverse migration of the testis is injury.

Severe symptoms of cryptorchidism are:

• scrotal asymmetry;
• inability to identify the testicle by palpation;
• aching pain in the groin and (or) abdominal area (not always).

The most likely complications of cryptorchidism

Against the background of an undescended testicle, very serious complications can develop:

• inguinal hernia (with subsequent tissue necrosis);
• torsion of the spermatic cord and blood vessels;
• testicular membranes;
• (the risk is highest with bilateral anomalies and late surgical treatment);
• development of malignant testicular tumors (10 times higher than in the absence of pathology).

Important:Testicular cancer most often develops if surgery was not performed and the intraperitoneal location of the testis is preserved.

If cryptorchidism is combined with an inguinal hernia, then there is a possibility of strangulation of the testicle with a loop of intestine in the inguinal ring. This complication is accompanied by intense pain and a sudden disruption (cessation) of blood supply. If emergency surgery is not performed, necrosis of the testicular and intestinal tissue develops.

Making a diagnosis of cryptorchidism is not difficult. The undescended state of one or both testicles into the scrotum is determined visually and by palpation. As a rule, in the groin area a swelling is detected in the projection of the testis. It is impossible to manually lower the testis into the scrotum.

Cryptorchidism is often accompanied by more or less pronounced underdevelopment of the scrotum.

Important:If during the examination the testicle is not palpable or developmental pathologies such as micropenia or hypospadias are revealed, the child may require additional consultation with a geneticist and endocrinologist. This is necessary to exclude pathology of sex formation.

To clarify the diagnosis, determine the location of the testicle and the condition of regional blood vessels, the following methods of instrumental research are used:

• testicular scintigraphy,
• Magnetic resonance imaging;
• venography of the testicular vein;
• angiography of the abdominal aorta.

In some cases, diagnostic laparoscopy may be required.

Treatment of cryptorchidism

Conservative techniques

Conservative treatment of this pathology involves hormonal therapy with the administration of human chorionic gonadotropin drugs. The probability of success is estimated at approximately 20%, and a fifth of patients experience relapses after completing the course. The lower the testes are initially located, the higher the likelihood of success of conservative treatment of cryptorchidism.

A universal hormone therapy regimen has not been developed. IM injections of gonadotropin are usually indicated twice a week. The duration of course therapy is 4 weeks. Treatment begins when the boy reaches six months of age.

Alternative drugs are synthetic analogues of luteinizing hormone releasing hormone

The question of the need for neoadjuvant (performed before surgery) and adjuvant (postoperative) hormonal therapy is decided individually in each specific case. These techniques are not considered standard.

If conservative treatment methods are ineffective, surgical treatment of cryptorchidism is resorted to.


The objectives of the operation are:

• prevention of complications (primarily malignancy of organ tissue);
• maintaining the ability to reproduce;
• preservation of testicular functions (hormone synthesis);
• elimination of a cosmetic defect.

Note:at older ages, the indication for surgical correction is psychosexual motives.

According to most experts, the best age for surgical intervention for cryptorchidism is the age from 5-6 to 18 months of life. Early surgical treatment minimizes the risk of developing testicular cancer, as well as impaired sperm production and hormone production.

Testicular reduction (orchiopexy) is a planned surgical procedure, the main goals of which are:

• traction of the spermatic cord;
• mobilization of the testis;
• formation of a bed for the testicle in the scrotal cavity;
• actually bringing down and fixing the testis in the desired area.

During the operation, it is important to avoid even minimal tension on the vessels. Properly carried out intervention subsequently makes it possible for the reduced reproductive organ to subsequently develop according to a completely normal pattern.

If it is impossible to palpate the testicles, i.e. if they are located too high, the best choice for treating cryptorchidism is laparoscopic intervention.

Important:if there is intraperitoneal placement of the testis on one side, and the other testicle is located normally, then at an older age it is recommended to remove the intraperitoneal testicle to avoid malignancy of the organ.

Boys with false cryptorchidism do not need treatment, but they are advised to be monitored until they reach puberty.

Forecast

The likelihood of complications with timely treatment is low, but it increases significantly if cryptorchidism is not eliminated before 2 years of age.

Up to 20% of men with unilateral pathologies and up to 80% with bilateral pathologies face the impossibility of conceiving.

Konev Alexander, general practitioner

An anomaly of child development in which one or two testicles are missing from the scrotum.

While the fetus develops in the mother's abdomen, the testicles form in the abdominal cavity. If development occurs normally, they later move down the inguinal canal. And by the birthday or for 2-3 months after birth, the testicles descend, returning to their normal state. But this process may be interrupted due to some reasons, which will be mentioned below.

Researchers have suggested that failure of the testicles to descend into the scrotum on time is associated with disturbances in the body’s hormonal system and the physiological characteristics of the child (underdeveloped inguinal canal or obstacles at its exit, short testicular vessels, etc.). In such cases, cryptorchidism is diagnosed in boys.

Types of cryptorchidism in children depending on the possibility of manual displacement of the testicle:

• true
• false
• elevated testicle

With true cryptorchidism in children, the testicle cannot be moved into the scrotum manually. If false, attempts to lower it are successful. This type of disease can occur with hypertonicity of the muscle that is responsible for raising the testicle. With ectopia, it goes to the thigh, then the ectopia is called femoral, to the groin (inguinal ectopia) or in the perineum. It is not possible to manually move the testicle to the desired location. When the testicle is elevated, it moves upward because the growth of the spermatic cord is slowed down.

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An undescended testicle is the most common surgical pathology, after inguinal hernia, that is detected in boys at birth.

In addition to psychological discomfort in a boy during adolescence, cryptorchidism often affects reproductive function, causing infertility in the future. Surgery for cryptorchidism in children is performed after 6 months to 1 year; it is before this period that the testicle can migrate into the scrotum on its own.

Cryptorchidism - what is it?

Cryptorchidism is the abnormal (outside the scrotum) location of one or both testicles. During the development of the fetus, the testicles are laid in the abdominal cavity and in the second half of pregnancy begin to descend into the scrotum along the inguinal canal. This process is completed by the birth of the baby.

However, 4% of children born on time do not have a testicle in the scrotum. An even greater percentage of pathology in premature babies is 15-30%. A cryptorchid testicle that has not completed the entire migration path from the abdominal cavity to the scrotum may be located:

• at the inguinal ring - in 40% of cases;
• directly in the inguinal canal - in 20% of newborns with cryptorchidism;
• in the abdominal cavity - 10% of all cases;
• on the thigh, under the skin on the pubis, in the perineum.

In most cases, a cryptorchid testicle is detected by palpation; if it is located in the abdominal cavity, palpation may not yield results.

Most often, right-sided cryptorchidism occurs, often combined with on the same side. However, in most newborns with cryptorchidism, the process of testicular descent is completed independently by 6 months due to high levels of sex hormones.

Persistent undescended testicle after 1 year remains in only 1% of children.

Causes of cryptorchidism in children

The following factors lead to incomplete descent of the testicle into the scrotum:

1. Genetic - a chromosomal disorder can occur if a pregnant woman has suffered an infectious disease (influenza, rubella, toxoplasmosis, sexually transmitted infections);
2. Endocrine - hormonal imbalance in a pregnant woman (diabetes mellitus, thyroid disease, pituitary pathology) and in the fetus;
3. Mechanical - there is an obstacle to the descent of the testicle: adhesions with the abdominal cavity, shortening of the spermatic cord, injuries and the consequence of surgery in the groin (inguinal hernia, hydrocele) in adults.

A pregnant woman should pay special attention to taking medications. Thus, Paracetamol, safe for the expectant mother, in combination with NSAIDs (Ibuprofen, Aspirin) increases the risk of developing cryptorchidism in the baby by 16 times.

Types of cryptorchidism and characteristic features

The type of cryptorchidism is decisive in determining the need for surgery. Also, various options for undescended testicles involve certain complications.

Types of cryptorchidism:

True cryptorchidism- diagnosed if an attempt to manually lower the testicle into the scrotum does not produce results. Often this pathology is combined with other congenital anomalies: hypogonadism, inguinal hernia, underdevelopment of the hypothalamic-pituitary system.

False cryptorchidism- manual reduction leads to movement of the testicle into the scrotum. This condition is caused by hypertonicity of the muscle that lifts the testicle. If in a normal state (the baby is calm, he is warm) the testicle is located in the scrotum, then when exposed to cold or crying, the testicle rises up, and the scrotum decreases in size and wrinkles.

Also, false undescendedness occurs when the diameter of the inguinal canal is larger in comparison with the size of the testicle. Even with the slightest tension in the abdominal wall and groin area, the testicle easily moves towards the inguinal ring and easily penetrates the canal.

• The most pronounced cryptorchidism is observed in children 2-8 years old; the disorder usually goes away by puberty.

Ectopic testicle- if the testicle descends incorrectly, it has passed through the inguinal canal and is located under the skin on the thigh, in the groin area, on the pubis or in the perineum. With this localization, the testicle is most susceptible to injury.

• Even after surgery, in most cases the patient remains infertile.

Symptoms of cryptorchidism, complications in children and adults

An undescended testicle is usually diagnosed immediately after birth when examined by a surgeon. Cryptorchidism in adults requires consultation with a urologist-andrologist. The disease is characterized by the following deviations:

• Shape of the scrotum - asymmetry of the scrotum or its underdevelopment and flattening (bilateral cryptorchidism);
• Nagging pain in the groin or abdomen, with the intra-abdominal location of the testicle, the pain increases with straining, constipation, tension in the abdominal wall, sexual arousal during puberty (adulting).

Normal testicular development and spermatogenesis take place only in the scrotum, the temperature of which is 1.5-3ºC lower than in the abdominal cavity. Therefore, the longer the testicle is located outside the scrotum and the higher the temperature of the internal environment of the body surrounding it, the higher the risk of rapid onset of changes in it at the morphological level.

If left untreated, irreversible degeneration of testicular tissue develops by age 3.

Violation of the production of male hormones - androgenic hypofunction is detected during adolescence. In boys, secondary sexual characteristics develop slowly or are completely absent (with bilateral cryptorchidism): groin hair, facial hair.

• Typically, adolescents with cryptorchidism have a high-pitched voice, their body type is female, and obesity often develops.

Incorrect placement of the testicle can lead to the development of the following conditions:

• infertility - caused by a decrease in the number of healthy sperm;
• strangulation of the testicle in an inguinal hernia - requires emergency surgery;
• testicular torsion - compression of the spermatic cord, consisting of vessels and nerves, leads to rapid necrosis of the testicle;
• seminoma - testicular tumor occurs 35 times more often in patients with cryptorchidism;
• compression of the testicle by the pubic bone when it is located in the groin;
• psychological discomfort, feelings of inferiority and problems in the sexual sphere.

Treatment of cryptorchidism in a child - is surgery necessary?

Cryptorchidism in children, with the exception of the development of complications, usually begins to be treated from 6 months to 1 year. Until this age, the child is regularly observed by a surgeon, since spontaneous displacement of the testicle into the scrotum is possible.

Cryptorchidism is eliminated by a urologist surgeon, and a pediatric endocrinologist is often involved in the treatment process. Depending on the type of cryptorchidism and the development of complications, various treatment options are used:

Hormone therapy- is appropriate only for false cryptorchidism and before surgery to eliminate bilateral cryptorchidism in children with karyotype 46XY. Gonadotropic hormones for cryptorchidism are administered intramuscularly (chrionic gonadotropin) or nasal drops (gonadorelin).

• In 2/3 of patients, hormonal therapy produces a therapeutic result. Treatment with gonadotropes is not carried out during puberty!

Orchiopexy- surgical reduction of a cryptorchid testicle. An undescended testicle is exposed through an incision in the lower abdominal wall. A second small incision is made on the scrotum. The testicle is pulled into the scrotum, if necessary, plastic surgery is performed on the muscles that hold it, and it is sutured.

• There are no consequences of such an operation for cryptorchidism performed before 2 years of age.

Orchiectomy- removal of the testicle is necessary when necrosis occurs due to torsion or pinching in the hernial sac. If the patient wishes (simultaneously with resection or during reoperation), implantation of an artificial or donor testicle is possible.

Treatment prognosis

Timely treatment (up to 2 years) virtually eliminates the development of complications. Right-sided, left-sided cryptorchidism is complicated by infertility in 20% of cases. Impaired fertility occurs in 70% of adult men with untreated bilateral cryptorchidism.

Children with undescended testicles need hormonal therapy before puberty to develop a male-type body.

Cryptorchidism is a male disorder characterized by the failure of one or two testicles in the scrotum. As a rule, boys get sick in infancy.

The most common form of cryptorchidism is congenital

Description of the disease

Statistics say that half of premature male children have right-sided cryptorchidism at birth, 30% of newborns are diagnosed with left-sided cryptorchidism, and 20% have a bilateral form. Doctors find that in 90% of children the disease disappears on its own in the first year of life, and for 10% of children medical care is required. The higher the underdeveloped testicle is located from the scrotum, the greater the likelihood of complications.

Causes of cryptorchidism

In medicine, the exact causes of cryptorchidism have not been established. However, experts say that the following factors can cause cryptorchidism in children:

The main suspected causes of the development of the disease: disorders in the endocrine system, genetic failure during the formation of the fetus in the womb and an anatomical obstacle.

Cryptorchidism develops with a sharp decrease in testosterone levels

Types of disease

There are several types of cryptorchidism, but the treatment for each form of the disease comes down to one thing - surgery.

Based on the location of the testicle, the following are distinguished:

• Abdominal cryptorchidism. It is observed when the testicle is undescended from the abdominal region.
• Inguinal cryptorchidism. It is characterized by the fact that the testicle, after exiting the abdominal region into the groin area, came out and remained there.

Depending on the location of the testicle, inguinal and abdominal cryptorchidism are distinguished

According to the degree of displacement of the glands, they are distinguished:

• False cryptorchidism. Characterized by the displacement of one of the testicles from the scrotum. Factors affecting movement are muscle tension and cold. With this form, the scrotum is symmetrical in a balanced state and develops within normal limits. When pressing, a gap in the scrotum is felt due to the warmth of the hands, and when the muscles of the groin area are tense, the gland is able to migrate into the fold of the groin.
  False cryptorchidism is just a feature of the boy’s physiology and its consequences are not so terrible. It may go away on its own and treatment is not needed until adolescence.
• True cryptorchidism is characterized by the impossibility of returning the gland to the seminal pouch manually, as in the false form. Basically, the sex gland is located in the groin ring, less often in its canal. With this form, either both testicles or one may be retained. True cryptorchidism is often accompanied by a hernia in the groin of men, the treatment of which is only possible through surgery. The consequences of true cryptorchidism threaten male infertility.
  This type of disease is often confused with testicular ectopia, in which the gland does not enter the scrotum, but the perineum.

True cryptorchidism is often accompanied by the appearance of an inguinal hernia

The first type of disease occurs in half of the recorded cases.

Based on the time of development of the disease, the following are distinguished:

• Congenital cryptorchidism. This form is observed at birth, when the baby’s gland does not descend during pregnancy. Often found in premature babies.
• Acquired cryptorchidism. The form of the disease is registered after birth. It affects boys aged 1 to 10 years.

According to the side of development of the pathology, unilateral and bilateral types of cryptorchidism are distinguished:

• Left-sided – absence of a testicle on the left side.
• Right-sided - absence of a testicle on the right side of the scrotum.

The acquired form of cryptorchidism is usually detected in boys under 10 years of age.

A boy in infancy is plagued by the following signs of illness:

• Sharp pain in the area of ​​undescended glands. The pain is replaced by an aching, nagging pain.
• Manifestation of pain when coughing, pressing, straining the body.
• Asymmetrical flat scrotum.
• Inability to detect the testicle by palpation.

At the age of 5 to 10 years, the boy complains of:

• Heaviness in the lower third of the abdomen and groin.

The disease causes pain in the lower abdomen and problems urinating

• Urinary problems and constipation. Pain during bowel movements.
• Increased body temperature.

In adult men, the listed symptoms are supplemented by a decrease in sperm production and quantity. Pain is recorded during erection of the penis.

Diagnosis of the disease

The diagnosis of cryptorchidism is made after visual examination and palpation of the scrotum. Any underdevelopment and flatness of the scrotum indicates pathology. If during palpation it is possible to return the gland to its usual position, a diagnosis of “false cryptorchidism” is made. And if, after palpation, it cannot be “put in place,” then “true cryptorchidism” is diagnosed.

The diagnosis of cryptorchidism can be confirmed using an abdominal x-ray

It is possible to confirm or refute the alleged diagnosis only after an ultrasound and radiography of the abdominal cavity. The pictures will show how far it is from the inguinal rings and at what level it is located.

If, after diagnosis, the pathology is in doubt, then they resort to MRI and CT diagnostics. Tomography is used when the testicle is located in the abdominal region. After diagnosis, the size of the underdeveloped gland becomes known. In case of congenital absence of the gland, the laparoscopy method is used.

In cases where children have a bilateral type of cryptorchidism, tests are necessary:

• Blood to determine hCG level. If the level exceeds the norm, then this indicates the development of a tumor.

A blood test is a mandatory test for bilateral cryptorchidism

• Blood for analysis of hormone deficiency.
• Blood for studying the set of chromosomes.

Treatment of cryptorchidism

If at least six months have passed (and if the baby is premature, about a year) and the child’s testicle has not descended, immediate treatment should be started. The boy is registered with a pediatric urologist, who individually selects treatment:

• Conservative treatment. Drug treatment includes taking a special group of hormonal drugs that will help in the growth of the gonad. Over the course of a month, the child is injected intramuscularly with the hormone choriogonin. With successful treatment, the testicle itself descends into the scrotum under its own weight. The underdeveloped gland will gradually begin to function normally. The course of treatment is repeated after 3-4 months.
  The effectiveness of treatment procedures is high if the testicle is close to the scrotum. Unfortunately, with this method of treatment there is a high probability of the pathology returning in children (about 25%).
  In abdominal cases, hormone therapy is useless.

Conservative treatment of cryptorchidism involves intramuscular injections of choriogonin

• Surgical intervention. If treatment attempts with medications are unsuccessful, then surgery is necessary to cure cryptorchidism. Before surgery, it is necessary to perform a biopsy to exclude the consequences of oncology. The entire process takes place under general anesthesia. Surgical correction of pathology occurs as follows:
  • an incision is made in the groin area;
  • the gonad is manually lowered into the seminal sac of the scrotum;
  • an incision is made in the scrotum;
  • The gland is sutured to the walls of the testis.

In the abdominal location, the laparoscopy method is used, when the testicle is lowered down through a puncture in the abdomen with a special instrument. If the gonad is underdeveloped, it is removed to eliminate the risk of developing cancer.

If drug therapy does not produce results, cryptorchidism is treated surgically

The chances of curing the disease are high. The main thing is to start treatment on time.

Disease prevention

Preventive measures should be carried out during pregnancy in the 2nd and 3rd trimester, because the disease is more common in its congenital form. The development of the anomaly is influenced by any negative factors, be it stress or a cold.

A woman who has close male relatives who have suffered from pathology needs to be especially careful. Therefore, you need to carefully plan your pregnancy and be treated in advance for viral infections and chronic relapses.

To prevent cryptorchidism in a newborn, a pregnant woman should avoid stress and be careful

After conception, you should avoid staying near any chemical reagents and do not take medications without consulting a doctor. For example, studies have found that taking Paracetamol increases the risk of cryptorchidism.

Complications of the disease

The causes of abnormal position of the testicle entail the following complications:

• difficulty getting blood supply to the testicle outside the scrotum;
• heat exchange disorder in the groin area;
• diseases of the genitourinary system;

Cryptorchidism causes the development of various diseases of the genitourinary system

• endocrine diseases, including discrepancies in the number of hormones in the body;
• increased risk of injury to the area where the testicle is located.

If proper treatment is not carried out, the consequences of cryptorchidism are very sad:

• testicular necrosis;
• hernia in the groin area;
• malignant testicular tumor;

Untimely treatment of cryptorchidism may result in infertility.

• infertility;
• impotence;
• disturbances in sperm production as a result of spermatogenesis.

In addition, a boy with a similar disease develops according to female characteristics: he does not grow a beard, has a soft voice, his body structure resembles that of a woman, etc.

How cryptorchidism is treated and why it is necessary to seek help in a timely manner - the video contains answers:

There is a male disease with which a newborn boy may be born. This is right-sided cryptorchidism. This pathology manifests itself in the fact that when the child is born, his right testicle is not in the scrotum. In newborn boys, cryptorchidism can be either right-sided, left-sided or bilateral. In the latter case, both testicles are not located in the scrotum. But the most common, observed more often than half of the cases of this disease, is right-sided cryptorchidism. Doctors made observations, as a result of which it turned out that this pathology is more typical for premature babies. It is among them that cryptorchidism manifests itself in 30-35 boys born out of 100. In full-term babies, this disease occurs 10 times less often - from 2 to 4 cases per 100 boys born.

Problems that arise with such a paired gland as the testicle should not be ignored by parents. In many cases, this pathology is the main reason for the absence of children in men who did not eliminate it in childhood. The fact is that it is in this paired male gland that sperm and male sex hormones are formed. Therefore, various diseases of the glands have a negative impact on the formation of both sperm and male hormones, having an overall negative impact on the health of the future man.

How does pathology arise and what are the causes of its occurrence?

When the child is still an intrauterine fetus, during each of its developmental periods the testicle travels a certain path, being in one place or another in the body. For example, in an embryo, the testicle begins its journey from the retroperitoneal cavity and strives to take a position in the intra-abdominal cavity. Before the fetus is 3 months old, the testicle will be located in the lumbar region, near the kidney, slightly away from the spine. Already closer to three months of the fetus’s existence, the testicle moves closer and closer to the inguinal canal, to its internal opening. However, it will penetrate into the inguinal canal itself only when the fetus is 7-8 months old.

Once the testicle is in the inguinal canal, it tends to descend into the scrotum, following where the guide ligament leads it. This ligament has the medical name gubernaculum testis. This canal, a kind of elevator that allows the testicle to find itself in the scrotum, is a vaginal process from the peritoneum, and it is open only until the child is born. Before the world hears the voice of a newborn boy, this abdominal process closes. That is, during intrauterine life, the testicle overcomes the route from the abdominal cavity, moving through the abdominal wall and inguinal canal, ending up in the scrotum.

What causes this male gland to enter the scrotum? Firstly, it is affected by a connecting cord called Gunterov, which connects the lower pole of the male reproductive gland of the embryo with the scrotum. This cord has an active effect on the testicle, as a result of which it tends to descend into the scrotum. Secondly, this process is ensured by the disproportionate growth of the fetus and the growth of its spermatic cord. Thirdly, the testicle is affected by the pressure inside the abdominal cavity that increases during fetal development and by the movements of the intestines, in which the lower section becomes filled with meconium. This filling occurs during the period when the glands finally descend into the scrotum. Fourthly, the descent of the gonads into the scrotum is influenced by the appendage of these glands, which during development stimulates additional descent of the testicles.

During the embryonic state of the fetus, its male gonads produce male sex hormones, known under the term androgens. The testicles will move through the inguinal canal as well as the concentration of these hormones is high. One of these hormones is called luteinizing hormone. It has the greatest influence on the promotion of the gonads. The child’s pituitary gland is responsible for its production during the last three months of his intrauterine life.

During pregnancy, the mother of the child produces gonadotropic hormones. These hormones have a stimulating effect on the production of androgens in the required amount, the concentration of which directly affects the movement of the testicles along the inguinal canal. A disruption in the mother’s body’s production of gonadotropic hormones can lead to a subsequent negative process that prevents the normal descent of the gonads into the scrotum. Various physical disturbances in the fetus itself can mechanically interfere with this process, which will lead to its deviation from the expected action.

Congenital hernia as a cause of the development of right-sided cryptorchidism

It was said above that the testicle is allowed to enter the scrotum by the inguinal canal, which is a vaginal extension from the peritoneum, which is obliterated immediately after the birth of the baby. But if the process of obliteration, or closure, does not occur in this process, then this can cause the occurrence of cryptorchidism, as shown by the majority of cases of this pathology. The reason is that this hole, from a few millimeters in diameter, can increase to the size of the lumen of a rather large hernia in the groin.

This leads to the common combination of inguinal hernia and cryptorchidism. Doctors conducted an observation and, taking into account the collected statistical data, came to the conclusion that this combination occurs in 92-95% of cases. In addition to the fact that cryptorchidism occurs, the failure of the said process to heal may be accompanied by the formation of edema of the lining of the gonad (or glands), which is delayed on its way to the scrotum.

What is accompanied by the occurrence of right-sided cryptorchidism?

In addition to possible hydrocele of the testicular membranes, cryptorchidism may be accompanied by strangulated hernia. This disease is congenital; it manifests itself just during the process of lowering the testicles into the scrotum. If the above vaginal process is not closed or closed at the time of the birth of a boy, then this hole will not remain empty. The testicles may be followed by internal organs, and this process will be diagnosed by a doctor as a congenital inguinal hernia. It is believed that an inguinal hernia is possible due to an underdeveloped abdominal wall, as well as ligaments. This pathology is possible either for hereditary reasons or due to negative processes occurring during pregnancy. This hernia does not go away on its own, and when the child reaches six months of age, it is repaired surgically.

Right-sided cryptorchidism may be accompanied by torsion of the gonad, which does not enter the scrotum. And that's not it. The most severe consequence of such a pathology may be the infertility of the future man, and the risk of cancer of this male reproductive gland greatly increases. The risk of cancer especially increases in cases where the testicle is characterized by an intra-abdominal location. As for infertility, it most often develops with bilateral cryptorchidism and can occur in two out of three cases of the disease. With right-sided pathology, this percentage is lower; it is observed in every third person suffering from cryptorchidism. For these reasons, if the testicle does not return to its place by the age of 1.5-2 years, then at the age of 6-10 years it is removed to prevent more serious diseases.

Various manifestations of cryptorchidism

This disease is divided into two types - ectopia and retention. The first type is characterized by the fact that the gonad deviates from its route when traveling to the scrotum. The testicle did not go where it was supposed to go. This pathology is characterized by the fact that the conductor of the gonad, which is normally attached to the bottom of the scrotum, changes the place of attachment if it is abnormal. Since the conductor serves as a guide for the movement of the testicle, the latter changes its trajectory of movement following the conductor, does not fall into the scrotum, but deviates to the side. With this type of pathology, the spermatic cord of the gland retains its natural length.

This type of cryptorchidism can manifest itself in several ways. For example, the gland may be located above the aponeurosis of the external oblique muscles of the abdominal cavity. In this case, it is considered that we are talking about superficial ectopia. The gland may be located at the base of the penis, resting on the pubic bone, and the doctor diagnoses penopubic ectopia. If the testicle is stuck near the thigh, entering Scarpa's triangle, then this cryptorchidism will be called femoral ectopia. Stuck in the perineum, the gonad will provoke perineal ectopia.

With retention, the following violation is observed. The normal route of the gland should be observed from the point of its formation, which is located near the lower pole of the kidneys, to the external opening of the inguinal canal. In this case, the retention of the gland can be both in the intra-abdominal part, along the entire path of the testicle, and at different levels in the inguinal canal itself.

Why is it so important that the male reproductive glands are located in the scrotum?

But really, what is important in the scrotum for the testicle to be located there? Does it matter where it is stored? The main thing is that the blood flows in full. This is an incorrect judgment. The scrotum has a very important function. Some know that to prevent unwanted pregnancy, there is a folk method that advises men to take a hot bath before sexual intercourse, after which his sperm lose their activity, and the chances of a woman becoming pregnant during sexual intercourse with such a man are small. Where did such a people's council come from?

The normal process of spermatogenesis is ensured at the required temperature.

Elevated temperature will inhibit this process, preventing the consequences of sexual intercourse, such as pregnancy. Therefore, in order for a man not to become infertile, his gonads must be exposed to normal temperature conditions.

It is this necessary balanced temperature regime that is provided by the scrotum. If the testicle does not enter the scrotum, but remains elsewhere, it is exposed to higher temperatures, which leads to impaired spermatogenesis. But long before the question of sperm production arises, the problem of the normal development of this gland will arise, which also occurs only under normal temperature conditions, and if it is disturbed, there may be underdevelopment. The temperature in the body is not much, but higher than in the scrotum. The difference is up to 5°, and this is quite enough to cause disturbances in the development of the male gonads and their functioning. Nature decided to create the scrotum and place the sex glands there for a reason. This could well have been done somewhere in the abdominal cavity, saving them from the increased likelihood of injury. It was necessary to create a powerful thermostat, which was achieved.

How to identify pathology in a child?

Pathology such as cryptorchidism is not difficult to detect. Even an external examination of the condition of the scrotum will help detect the absence of one or both male sex glands. And if the glands are retained in the groin area, then it may become swollen. Trying to restore the normal position of the glands through treatment and therapeutic effects on this gland and organs of the genitourinary system will lead to nothing. The pathology is characterized by significantly wider damage to internal organs, including the scrotum itself, which in such cases is distinguished by its underdevelopment of varying degrees. A differential approach to eliminating the pathology and its consequences may be required, which will require contacting different specialists, such as a geneticist or endocrinologist. It happens that the cause of the disease may be a violation of the formation of the child’s sex, and in order to identify this, it will be necessary to determine its karyotype.

But sometimes it may happen that the child experiences some kind of reflex, called by doctors the cremasteric reflex, during which the sex gland is pulled into the inguinal canal by contracting the cremasteric muscle. Such work of this muscle can be provoked either by a stressful situation that the child is experiencing or by hypothermia. Most often this effect occurs in children aged 5-7 years. In this case, there is no question of cryptorchidism; the testicle calmly returns to its place under the influence of manual therapy. This phenomenon is called false cryptorchidism and, unlike real pathology, does not require serious medical intervention.

How to cure the disease?

The first treatment option for cryptorchidism is to administer medications to the patient. This treatment method is not very effective and helps one in five people who get sick. Of those who benefit from this treatment, 20% experience a recurrence of the disease as soon as they stop taking the medication. Doctors concluded that this method is not suitable for treating pathologies in which the male reproductive gland is located very high. Drug treatment is suitable for testicles located low to the scrotum.

Drug treatment varies greatly and depends on the degree and type of pathology. But the most interesting thing to consider for parents of boys with this condition is that there is no established evidence that one treatment is more effective than another. The standard approach is that drug treatment begins, as a rule, from the child’s six-month or one-year period of life. Human chorionic gonadotropin preparations are administered 2 times a week, and this continues for 4 weeks.

But self-medication is excluded here. Complex diagnosis, prescription and monitoring of treatment requires exclusively medical education and experience.

No folk recipes for hot baths work in this case, since such methods only work on false cryptorchidism. And if the disease is real, a doctor will be needed.

As for surgical intervention, practicing doctors proceed from the following. For up to 1 year, drug treatment of diagnosed right-sided cryptorchidism can be used. There is a chance that the testicle will descend on its own, but it is very small. Further, if the pathology has not resolved by one year, doctors believe that the boy’s problem cannot be cured in the future, and they strongly recommend removing the undescended gonad. Some doctors are convinced that for right-sided cryptorchidism, treatment with hormones is considered ineffective and is not recommended. This method works best if both testicles are not in the scrotum.