What is cryptorchidism?
Cryptorchidism is a medical term indicating undescended testicle. It is typically detected during a postnatal examination or revealed during a general examination shortly after birth. It may affect one or both testicles. However, the rate of cases in which both of them do not descend is 10%. It is seen in approximately 30% of male babies born prematurely and in 3-5% of male babies born at normal time. When the baby is about three months old, the testicle may also descend spontaneously. In approximately 1% of babies with undescended testicles, the testicle remains undescended after three months. While the male fetus grows in the womb, the testicles form in the abdomen. During the process, the testicles gradually descend and settle into the scrotum. These sacs are located behind the penis. Generally, if one or both testicles are not implanted in the scrotum when the baby is born, it means the baby has cryptorchidism. This is not a painful condition. However, they should be followed carefully for a few months and it should be determined whether they go down on their own. If they do not descend, the baby should be treated.
During the routine postnatal examination, the doctor tries to feel whether the baby's testicles are in place by palpation. If the testicles are felt in place, then they are called palpable. If one or both testicles cannot be felt, there is a possibility that they are in the abdomen. They are either too small to be felt or are out of place. It is very rare for the testicle to never form. The testicle can also be retractile.
Retractile testicle is different from undescended testicle and is not considered as undescended testicle. Retractile testicle is sometimes evident by the testicle that can be felt and sometimes cannot be felt. When checking your child's testicles, you will feel that the testicle is in place at some times, such as at bath time, and not in place at other times. This condition is evident when the muscles supporting the testicle occasionally and temporarily pull the testicle back into the abdomen or groin as a result of reflex contractions. In such cases, the testicle descends normally in adolescence and surgical intervention is not required.
The causes of cryptorchidism are not fully known. However, having cryptorchidism in a close relative such as a father or brother Some factors, such as premature birth or low birth weight, increase the risk. If a baby's testicles have not descended several months after birth, then they must be treated. Detecting an undescended testicle has many benefits: Increased fertility in later life, easier examination for testicular cancer, and elimination of psychological problems that may arise as a result of the visual deficiency caused by the absence of a testicle.
The main function of the testicles is the production of male hormones and sperm. However, for this production to occur, a lower temperature than body temperature is required. For this reason, sperm production takes place in the testicles in the scrotum, which is colder than the body. If cryptorchidism is left untreated, the child will be infertile later in life, meaning he or she will not be able to have a child. The probability of cancer occurring in testicles that have not descended naturally and are not treated is very high. In addition, when the testicle is in the scrotum, it is easier to be examined by the person himself or by the doctor.
Boys are very sensitive about the masculinity they feel. Undescended testicle causes the scrotum to appear small, flat and empty. The child with this condition does not feel good about himself and his body, especially during adolescence and adolescence.
The aim of cryptorchidism treatment is to prevent other potential problems that follow this disease. The most common problems associated with undescended testicles are testicular tumors, subfertility, testicular torsion and inguinal hernia.
TESTICULAR CANCER
Studies show that testicular cancer occurs normally in men with undescended testicles. showed that it is more common than those with In 20% of patients with testicular tumors and unilateral undescended testicles, the tumor is observed in the normally descended testicle.
Cryptorchidism and testicular cancer may also be a clear indication of genetic testicular abnormalities. Therefore, a testicular cancer that develops in an undescended testicle may not be due to testicular malposition. There is also no evidence that orchidopexy increases the risk of testicular cancer.
Sperm count and quality are low in men with undescended testicles and men with normal descended testicles They have a lower reproductive rate than . The risk of subfertility increases with bilateral undescended testicles and higher age at the time of orchidopexy. Disruptions in sperm formation may also be due in part to underlying genetic abnormalities.
TESTICULAR TORSION AND INGUINAL HERNIA
Although there is not enough evidence, testicular torsion is seen at a higher rate in patients with undescended testicles than in patients with normally descended testicles. . Torsion formation in undescended testis is generally observed in the presence of a testicular tumor. Presumably, increasing weight and deterioration of the normal dimensions of the organ cause this situation. Intra-abdominal testicular torsion may occur as an acute abdomen. A nonpalpable testicle that cannot be felt during physical examination may be a clue for the diagnosis of torsion, but torsion is usually only revealed during detailed abdominal examination.
In many cases of undescended testicle, patent processus vaginalis accompanies. If there is an obvious hernia, rapid hernia repair with orchidopexy should also be considered during diagnosis. Otherwise, a hernia can also be treated during orchidopexy
Image and Anatomy
Many cases of undescended tetsis are evident immediately after birth . 1 in 3 newborn premature male babies have an undescended testicle. When the baby is 3 months old, the incidence drops to 8 per 1000. This rate does not change until adulthood. It is wrong to wait because the undescended testicle if it does not descend by 3 months, it rarely descends thereafter.
Occasionally, the testicle that was found to be in the scrotal position in infancy “rises” and becomes an undescended testicle. . Although doctors state that this is a case of unformed testicle that could not be detected at the first examination, today testicular elevation is a detected phenomenon. This problem is observed in relatively older babies and young children. However, it is a very rare condition.
Based on the findings as a result of physical and surgical applications, undescended testicle can be classified as follows: a) True undescended testicle (on the normal descent path the one which); b) Ectopic testicle; c) Retractile t estis
Physical Examination
A general physical examination highlighting signs of syndromic features, Prader-Willi, underlying causes of undescended testicle It may cause syndromes such as Kallmann's or Laurence-Moon-Biedl. The genitalia should be checked for hypospadias or ambiguity. In cases where hypospadias and undescended testicle coexist, intersexuality, especially gonadal dysgenesis and true hermaphroditism, are usually accompanied.
The testicular examination of infants and young children is performed with two hands. One hand starts at the hip and gently scans along the inguinal canal. If necessary, scanning can be facilitated by applying surgical lubricant or warm soapy water to this hand. During this maneuver, the true undescended testicle or ectopic testicle will be felt as a slightly “prominent” bulge under the fingers. A low ectopic or retractile testicle becomes palpable with the other hand when it “slips” into the scrotum. Once released, the ectopic testicle will immediately come out of the scrotum. The retractile testicle will remain in the scrotum, even for a short time, until stimulated by another cremastric reflex. In other words, the testicle may come out of the scrotum or briefly change its location due to situations such as the child's fear or excitement or temperature changes.
Children with retractile testicles should be followed as they grow. In some cases, the testicle may descend, and sometimes it may not descend, so it may need to be treated. Distinguishing between a retractile testicle and a true undescended testicle may be difficult in some cases. In this case, consultation with a pediatric urologist is important. Position, stability and proportional dimensions of the undescended testicle to the normal testicle should be taken into account. If a testicle cannot be palpated in the scrotum or inguinal canal, or in ectopic areas such as the femoral region or perineum, evaluation of a nonpalpable testicle should be performed. Sometimes the tissue in the scrotum can also feel like a haricocele.
Undescended Testicle Treatment
Undescended testicle treatment can be applied hormonally, surgically or a combination of the two.
SURGICAL TREATMENT
Post-operative care is quite simple. testicle To prevent dislocation of the scrotum, activities/games that involve sitting with legs open, such as cycling, should be avoided for 2 weeks. Additionally, sporting activities should be restricted in older children.
During the early postoperative examination (1-2 weeks after surgery), the physician evaluates the healing of the wound and removes the stitches. The control examination is performed 3 months after the surgery, and in this examination the location and size of the testicle is checked.
The most notable of orchiopaxy is testicular atrophy. Opening of the testicular vessels and/or postoperative swelling and inflammation may cause ischemic damage and testicular atrophy. Other possible complications include re-elevation of the testicle (in which case repeat orchiopexy may be recommended), infection, and bleeding.
Orchiopexy should be performed by pediatric urologists.
NONPALPABL TESTICULAR SURGERY
Nonpalpable testicle surgery is a practice for both diagnostic and therapeutic purposes. It is important to first detect the presence of a testicle. If the absence of a testicle is determined during surgery, even with blind-ended testicular vessels, surgery should be terminated. Sometimes the testicular vessels are connected to the abdominal, inguinal or scrotal testicular remnants. These remains should also be removed. However, in almost half of the cases, an abdominal testicle is detected, which must either be removed or lowered into the scrotum.
There are two approaches to surgery for nonpalpable testicles: open from the groin and diagnostic laparoscopic. In the open groin surgical approach, the groin is completely examined. If there are any connecting structures or testicular remains, they are removed and the operation is terminated. If the result of the groin examination is negative, the incision is widened and the peritoneum is entered to detect the intra-abdominal testicle.
The second surgical approach for nonpalpable testicle is laparoscopic. A laparoscope is inserted through the belly button and the inguinal rings and processus vaginalis condition are examined. Wolffian structures and testicular vessels are easily identified. Blind-terminated sperm channels confirm the absence of a testicle and enable the operation to be completed without any groin incision. If the veins and sperm ducts emerge from the internal ring, then groin examination
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