How to treat cryptorchidism

Cryptorchidism is a pseudo-testicular tissue that affects male fertility, causing normal reproductive cells to be damaged and fixed to the scrotum, which can lead to decreased sperm ability, malignant changes, and testicular sprains. It is a very serious male disease that requires timely treatment. Cryptorchidism needs to be removed surgically to prevent the testicles from descending, and hormones can also be used for treatment.

Clinical manifestations

1. Infertility

Cryptidysty can cause damage to reproductive cells. Early surgical treatment is needed to fix the testicles to the scrotum to reduce the risk of reduced fertility. The earliest postnatal histological abnormality of cryptidysty is the dysplasia of interstitial cells that can be observed in the first month after birth. Unilateral cryptidysty after puberty should be removed because it is prone to malignant and torsional changes in the future, and most testicles have lost their fertility.

2. Malignant change

Children born with undescended testicles are at risk for testicular malignancy. The incidence of germ cell tumors in men with a history of occult testes is about 40 times higher than in the normal population. The location of the undescended testicles affects the relative risk of testicular tumors, with the higher the location, the greater the risk of malignancy. Half of the intra-abdominal testes will develop malignancy. The most common type of testicular tumor arising from the testicles is a seminoma. The incidence of carcinoma in situ in men with occult testes is 1.7%.

3. Hernia

90% of patients with undescended testes have a patent processus vaginalis. The processus vaginalis usually closes after testicular descent and within the first month after birth. A patent processus vaginalis is associated with a higher risk of epididymal abnormalities. The clinical significance of a patent processus vaginalis is that it can affect the efficacy of hormonal treatment for cryptic testis.

4. Testicular torsion

Cryptotestis may have abnormal attachment of the gubernaculum, levator testis, or tunica vaginalis, which predisposes to testicular torsion. Although undescended testicles rarely torsion, testicular torsion should be considered in patients with abdominal or groin pain accompanied by lateral scrotal hollowness.

treatment

The ideal age to preserve fertility is 12 to 24 months after birth. Spontaneous testicular descent can be completed within 3 months after birth. Definitive treatment of undescended testicles should be completed between 6 and 12 months after birth, which is the best time to perform testicular descent fixation.

1. Hormone therapy

Cryptorchidism may be associated with hypothalamic-pituitary-gonadal axis abnormalities, and hormone therapy uses HCG, LHRH, or a combination of both. The guidelines recommend βHCG for preoperative preparation of inaccessible cryptorchidism or some reoperation cases, which increases testicular blood supply and facilitates surgery.

2.Surgery

For those whose testicles have not descended into the scrotum after 6 months of birth, surgery should be performed as soon as possible. For adolescent patients with cryptorchidism, testicular descent and fixation should be performed as soon as it is discovered. If the testicles are found to be atrophic or unable to descend into the scrotum during the operation, orchiectomy can be performed if necessary.

(1) Open surgical testicular descent fixation is performed on patients with palpable cryptic testicles. Generally, the approach is through the inguinal groove, an oblique incision is made in the inguinal groove, the spermatic cord is freed, the unclosed processus vaginalis or hernia sac is ligated, and the testicle is placed and fixed in the scrotum without tension.

(2) Indications for laparoscopic surgery: all inaccessible testicles; diagnosis of suspected intercourse; biopsy or intraperitoneal high-positioned testicle removal. Contraindications: acute infection, coagulation abnormalities, previous history of abdominal surgery, suspected peritoneal adhesions.

(3) Autologous testicular transplantation is suitable for high-positioned cryptic testes. The testicular blood vessels are ligated, the testicle is moved freely into the scrotum, and the testicular blood vessels are anastomosed to the inferior epigastric artery. This is not a widely used method and is not recommended as a routine surgical method.