Pediatric Surgery Specialist Prof. Dr. Feryal Gün Soysal; He explained what you need to know about undescended testicle, inguinal hernia treatment and circumcision.
Undescended testicle and its treatment
The testicles, which are formed in the womb at the level of the kidneys, which we call the retroperitoneal region, are placed in the scrotum. They show a correct descent. The descent of the testicles, which are usually in the scrotum at birth, may be delayed by 6 months to 1 year. If the testicles are not in the scrotum after 6 months, there is an undescended testicle and this anomaly is called cryptorchidism. Undescended testicle is seen with a frequency as high as 3-5% in normal newborns and 25-30% in premature newborns. After one year of age, it is seen in 3-5% of prematurely born children and 0.5-0.8% of term-born children.
The failure of the testicles to descend into the scrotum is attributed to hormonal deficiency in the intrauterine period (in the womb). In addition to the hormonal effect on the descent of the testicles, structures related to the inguinal canal such as the processus vaginalis, cremaster muscle, guberneculum and genitofemoral nerve also have an effect. Mechanical reasons may also play a role in the disruption of testicular descent in anomalies such as abdominal wall defects.
What are the disadvantages of not having the testicles in the scrotum?
-
Decrease in spermatogenesis function: Germs within the testicular tubules In order for the cells to mature and produce spermatozoa, they must be in the scrotum at a temperature 1.5-2.5°C lower than the body temperature. When the testicles do not descend normally, they remain at a higher temperature and normal spermatogenesis cannot be achieved unless corrected.
-
Risk of malignancy: Compared to the normal population, the frequency of seminoma in cases of undescended testicles is 30-30%. It is 40 times more. The possibility of malignancy is even higher in upper localized and atrophic undescended testicles.
-
Contralateral effect: In cases of unilateral undescended testicles, the descended testicle on the opposite side as a result of autoimmune reactions. may also be affected. For this reason, infertility may also occur in cases of undescended unilateral cryptochidism.
-
Torsion: Undescended testicles can easily torsion because they are not fixed to the scrotum. . Since the fixation of the testicles lowered into the scrotum is ensured, the possibility of torsion is reduced.
-
Hernia: In undescended testicles, there is usually an indirect inguinal hernia or an unclosed processus vaginalis. When a hernia is detected, in addition to hernia repair, the testicles are lowered into the scrotum.
-
Trauma: The risk of trauma is very high, especially if the testicle remains in the inguinal canal.
-
Trauma: The risk of trauma is very high. p>
-
Psychological problems: Especially at school age and before puberty, if the testicles have not yet been lowered into the scrotum, many of these children may have psychological problems.
How do we diagnose undescended testicles?
The testicles cannot be palpated in the scrotum. They are usually palpated in the inguinal canal. If it cannot be palpated in the inguinal canal, it may be higher up. In cases of non-palpable testicles, techniques such as HCG test, ultrasonography, computerized axial tomography, scintigraphy, venogram and laparoscopy have been described to show the presence or location of the testicle, but it is believed that surgical exploration is necessary in such cases.
No treatment. It must be distinguished from retractile testis, which does not require testicles. Retractile testicles are testicles that have completed their normal descent and are fixed in the scrotum; However, as a result of hyperactivation of the Kramester muscle, they can be pulled towards the inguinal canal, especially in contact with cold. In a well-performed inguinal examination, testicles can be palpated in the scrotum in case of retractile testicles.
So what is the treatment?
Due to the role of hormonal status in the descent of the testicles, medical treatment is preferred. However, the most preferred method in the treatment of cryptochidism is orchidopexy, that is, surgically lowering the testicles into the scrotum. Although gonadotropin (HCG) and gonadirelin (LHRH) treatments are used as medical treatment, the results are not always satisfactory. However, it is suggested that a positive effect on testicular functions can be achieved by giving medical treatment before and/or after surgery.
Endocrine and genetic evaluation should be performed in children where bilateral testicles cannot be palpated and in children with extragenital structural disorders such as hypospadias. stroke from 6 months If the diagnosis of retracted testicle is made, it would be appropriate to perform the operation.
Hernia and its treatment
The most common diseases that require surgical intervention in children are related to the inguinal region. Inguinal hernia, undescended testicle and hydrocele are inguinal region diseases that we frequently encounter in children.
How does an inguinal hernia occur?
The processus vaginalis passing through the inguinal canal normally closes at birth, after the testicles complete their descent into the scrotum. Although the processus vaginalis may remain open until older ages, a hernia may not occur in every case of open processus vaginalis. Indirect hernias, especially in girls, sometimes occur as a result of the herniation of the ovaries into the processus vaginalis. Direct and femoral hernias are very rare in children.
In which age group is hernia common?
Hernia is more common in premature babies and is more common under one year of age. Its incidence is 8-10 times higher in boys than in girls. It is seen in one in every 40-50 boys.
What kind of complaints does it cause in children?
The first symptom is the appearance of a painless swelling in the groin area. The swelling is caused by intra-abdominal structures that have entered the hernial sac. This swelling may increase if you cry, cough, or stand for a long time. The swelling disappears during sleep and when external pressure is applied by hand. Approximately 60% of the cases are seen on the right side and 25% on the left; About 15% are bilateral.
What is the treatment of hernia?
Inguinal hernia in children should be treated surgically as soon as possible after diagnosis. The surgery can be performed by open or closed method. It is a day surgery.
What happens if the hernia is not operated on?
If inguinal hernias are not treated when diagnosed, they may become incarcerated. This is colloquially called drowning. Strangulation may occur in more than one third of inguinal hernias in children. The probability of this condition occurring is higher in young children and infants. In these cases, the herniated intestinal segment may become compressed, causing pain, discomfort, and symptoms of intestinal obstruction. If reduction is delayed, The clinical picture becomes worse and that part of the intestine may necrose. As a result of the pressure of the incarcerated hernia on the testicle and spermatic vessels, hemorrhagic infarct findings in the testicles may develop, which will negatively affect future fertility.
Circumcision
Circumcision, the glans penis in men. It is a surgery to remove excess skin covering the body part. There is no consensus on whether it should be done for everyone. It is mostly done for religious or traditional reasons. It should be done under sterile conditions because circumcision is a surgery and can be performed with local or general anesthesia.
Circumcision can be performed at any age. Circumcision is not recommended between the ages of 2-6 because it is the period when sexual identity is determined. Therefore, it should be done under the age of 2 or from the age of 6 during the primary school period. Circumcision can be performed at earlier ages for protective purposes due to unpreventable clinical infection and adhesion in the foreskin. We often recommend newborn circumcision, especially since the pain threshold is different in the neonatal period and wound healing is rapid.
Those who have a disability for surgery and anesthesia, those with bleeding and clotting problems, diabetes, hormonal disorders, after being prepared with medical precautions. Then he can be circumcised. It would be appropriate for these people to be kept under observation in the hospital after circumcision.
Read: 0
