Treatment methods for cryptorchidism, commonly hormones and surgery

The testicles are an important part of the male reproductive organs and are also prone to diseases. Cryptorchidism is one of them. Cryptorchidism is a condition in which one or both testicles of a man do not enter the scrotum. In clinical treatment, hormone therapy and surgery are often used for cryptorchidism.

1: The cause of cryptorchidism, especially bilateral cryptorchidism, may be related to endocrine factors. Therefore, endocrine treatment can be given after the age of 1. The currently used endocrine treatments include:

2: Human chorionic gonadotropin (HCG): The purpose of treatment is to improve the function of Leydig's cells and Sertoli cells, promote testicular development, increase testosterone secretion, and promote testicular descent. The effective rate is about 14% to 50%, and the dosage is 1000 to 1500 U. It is injected intramuscularly every other day and followed up after 1 month. The total dose should be >10,000 U. 20,000 U does not increase the efficacy. On the contrary, it will have the adverse reaction of promoting testicular atrophy.

3: Luteinizing hormone-releasing hormone (LH-RH): The effective rate is 30% to 40%, the dosage is 1.2 mg/d, 200 µg in each nostril, 3 times/d, inhaled through nasal atomization, 4 weeks as a course of treatment, follow-up after 3 months.

4: LH-RH HCG: The combined use of the two can improve the therapeutic effect. The dosage of LH-RH is 1.2mg/d, inhaled through the nose nebulizer 3 times. After 4 weeks, HCG 1000~1500U, once a week, for a total of 3 weeks.

1: Orchiopexy is the main method for treating cryptorchidism. If the initial diagnosis is more than 6 months or hormone treatment is ineffective, surgical treatment can be performed after 1 year old. External fixation of the testicular sac with an oblique incision in the inguinal groove has been widely used at home and abroad. For cryptorchidism with short spermatic vessels, the surgery can be divided into two stages to fully ensure the blood supply to the testicles, but there is also the possibility of accidentally injuring the spermatic vessels in the second surgery.

2: The Fowler-Stephens procedure can be applied to long-loop vas deferens with high-positioned occult testis. Recently, a modified method of this procedure is recommended, the Fowler-Stephens staged surgery, that is, the initial surgery only cuts the spermatic cord vascular pedicle at a high position without testicular fixation. In the second stage, after the collateral circulation is enriched and established, the testicle is fixed in the scrotum, reducing the chance of testicular atrophy.

Indications should be considered based on the natural descent of the cryptorchidism, degeneration, fertility, and treatment efficacy.