Cryptorchidism in a child: photo, treatment, how the operation goes, reviews

2024 Author: Priscilla Miln | [email protected]. Last modified: 2023-12-16 00:21

Cryptorchism in children is a congenital pathology in boys, in which one testicle does not descend into the scrotum, and sometimes both. They may remain in the inguinal canal, in the abdomen, or in the upper part of the scrotum. It is a common disease in pediatric urology, affecting about 4% of full-term boys and about 20% of premature babies. Such a large percentage difference is due to the fact that the testicles descend into the scrotum in late pregnancy, almost before childbirth. If the birth began before the due date, then this phenomenon did not have time to occur. But still, in most children, by the end of the first year of life, the problem disappears on its own, as the testicles descend into the scrotum on their own. In other cases, surgery may be required, as undescended testicles can lead to serious consequences in the future, such as infertility and cancer.

Photo of cryptorchidism in children

Belowillustrated material is provided to help imagine what the disease looks like.

It is very important to know what the disease is in order to identify it in time and start treatment.

Classification

Depending on the location of the testicles, cryptorchidism is classified as:

• Abdominal - when the testicle is found in the abdominal cavity. In diagnosis, sometimes even an ultrasound can't locate the testicle. It is treated only by the operative method.
• Inguinal - when the testicle is located in the groin area.
• One-sided - when one testicle has not descended.
• Bilateral cryptorchidism in children - when two testicles do not descend into the scrotum. Sometimes occurs with hormonal disorders at the stage of intrauterine development. In this case, it is very important to start treatment as soon as possible, without waiting for the effect of hormonal therapy, since with bilateral undescended sperm production, the death of cells involved in the production of spermatozoa is about 70%.

In most cases right cryptorchidism is detected.

Also distinguished:

• True form - when undescended testicles were discovered immediately after birth
• False cryptorchidism in children - when at birth the testicles were palpated in the scrotum, but after a while the doctor could not identify their correct location. This form of cryptorchidism does not require treatment and resolves at the beginning of a boy's puberty.
• Ectopic testis - when the testicles descended, but not into the scrotum, but into uncharacteristic areas for this(groin, pubis, perineum, thighs, etc.). Often this occurs due to a mechanical obstruction. Unfortunately, with this form of the disease, even after treatment, most of the boys remain infertile.
• Recurrent cryptorchidism is a pathology in which, due to a lag in the development of the spermatic cord, the testicles rise again up from the scrotum

After the classification of cryptorchidism, the doctor decides on further treatment of the child.

Causes of cryptorchidism

At this time, the exact causes of this pathology are unknown. Doctors identify only a number of factors that can lead to such an anomaly in babies:

• chromosomal abnormalities;
• genetic predisposition;
• preterm birth;
• hormonal disorders in the mother during pregnancy (diabetes mellitus, thyroid disorders);
• multiple pregnancy;
• toxic effects on the fetus (alcohol, smoking, taking drugs that are prohibited during pregnancy);
• viral diseases during pregnancy;
• narrow inguinal passage or short spermatic cord, etc.;
• More than 80% of undescended testes coincide with congenital inguinal hernia.

If at least a couple of the above factors are found during the period of bearing a child, you need to more carefully monitor the development of the baby.

It has been proven that if the future mother observes the rest and nutrition regimen, the risk of cryptorchidism in children is significantly reduced.

Diagnostic methodscryptorchidism

The presence of cryptorchidism in a boy is diagnosed by a urologist. As a rule, it is not difficult to determine this pathology. The following methods are used for diagnostics:

• Examination and palpation of the scrotum, inguinal region. It is very important that the office is warm, as in a cool room, reflex testicular elevation due to muscle contraction can occur.
• If during the examination the doctor notes the absence of one or two testicles, an ultrasound examination of the inguinal and abdominal regions using Doppler ultrasound is prescribed.
• In more severe cases, an MRI or CTE procedure may be recommended (mostly such an analysis is prescribed for suspected complete absence of one or two testicles).
• A blood test for hormones.
• Sometimes laparoscopy is recommended for diagnosis.

It is worth noting that testicular palpation should be carried out even in the hospital. And if non-omission is found, this diagnosis is indicated in the certificate of discharge. But an inattentive examination of this part of the child's body leads to the fact that children are discharged without specifying the presence of this problem. In this regard, parents may not know until a certain age that their son needs control and treatment. In the presence of advanced cryptorchidism, the boy may have problems. Therefore, it is recommended that you independently examine the inguinal region of your baby in order to contact a specialist in time.

Symptoms of cryptorchidism

Here's what to look out for:

• On examination, one or two testicles are not palpated in the scrotum.
• Drawing pains in the groin. But there is no pain or discomfort during urination in newborn babies or older boys.
• When probing, you can find a testicle in the abdominal cavity, in the thigh or in the perineum.
• Genital asymmetry.

Complications of cryptorchidism

It is important to understand that cryptorchidism is a very serious disease that requires mandatory timely treatment. The most dangerous complications of this disease include:

• Testicular injury. With an uncharacteristic location for him, the testicle can be damaged even by light pressure on it.
• Inguinal hernia, which can be a serious threat to a boy's life (threatened strangulation).
• An undescended testicle sometimes becomes a site of inflammation.
• Hormonal failures. With cryptorchidism, a child has a suppression of male hormones.
• Testicular torsion. This complication requires emergency surgery. It is characterized by acute pain and impaired blood supply.
• Infertility. For the production of sperm, a certain temperature regime is necessary, which is present in the scrotum. If the testicle is located in another area of the body (with an elevated temperature), then the sperm production process is disrupted. There are times when sperm stops being produced at all.
• Testicular cancer. With the development and lack of treatment, mutations occur inside the organ,which can provoke the development of malignant tumors.

With cryptorchidism, the risk of infertility increases by 70% of cases, and testicular cancer by 80%.

Note that the above complications may appear when treatment is completely ignored or when detected late. Otherwise, this disease is completely curable.

Treatment

Treatment of cryptorchidism in children begins with an undescended testicle after six months of age. But basically, if at birth one or two testicles were not in the scrotum, they descend there until the baby reaches the age of one month. In premature babies, this period can be extended up to 12 months. At this time, the control of the doctor is very important.

Treatment of cryptorchidism in children is possible in two ways:

• conservative;
• operational.

With the conservative method, drug treatment with hormonal drugs is prescribed. Use intramuscular injection of hormones such as gonadotropin-releasing hormone and hCG. In addition to this, the endocrinologist prescribes a number of vitamins.

As a result of this method of treatment, testicular prolapse can be achieved in 50-60% of cases. But some doctors do not recommend using this method in children with unilateral cryptorchidism, when one testicle is he althy and functioning normally, because large doses of hCG can adversely affect it. With intensive hormonal therapy, early puberty may begin.

With false cryptorchidism, along with hormonal therapy, the doctor may trylower the testicle into the scrotum by palpation.

If conservative treatment fails, a surgical procedure called orchidopexy is prescribed. Cryptorchidism in children is treated by surgery at the age of not earlier than 2 years. But some experts insist on carrying out the procedure before the child reaches one and a half years.

In the treatment of cryptorchidism in children, surgery can be performed in two ways:

• open operation;
• laparoscopy.

The open method is used when the abnormal testicle can be felt. Here, a very important point is to determine the length of the spermatic cord. If it turns out to be short, then about a month before surgery, a course of hormonal drugs is prescribed.

Many parents wonder: if a child has cryptorchidism, how is the operation going? With open intervention, this happens like this:

• first an incision about 2-3 cm is made in the groin area;
• then the surgeon searches for the testis;
• if it atrophies, it is removed;
• then an incision is made on the scrotum, in the place where the testicle will be transferred;
• actually the transfer of the organ itself and suturing it to the wall of the scrotum;
• suturing.

The laparoscopic method is used in the case when it was not possible to locate the organ or when both testicles did not descend. The operation is performed with a special device - a laparoscope. The device is inserted through the patient's navel andtesticle is searched:

• if a testicle of standard size is found, and the spermatic cord is of sufficient length, the organ is lowered into the scrotum area;
• if the testicle is found, but the spermatic cord is short, then the vessels of the organ with a defect are clipped, and the operation itself is postponed for 6 months;
• if no testicle is present, implantation is performed (but it should be noted that this only applies to adult males, children are implanted only when they reach puberty).

It is worth noting that a two-stage operation is recommended for bilateral cryptorchidism. First of all, the testicle, which is closer to the scrotum, is brought down. In this case, there is a possibility of its hormonal beneficial effect on the other testicle. There are many positive reviews about the operation of bilateral cryptorchidism in children. But in this case, it is very important to start treatment as soon as possible.

As a rule, such an operation lasts no more than 90 minutes. It is performed under combined or local anesthesia. The patient is discharged after 2-3 days, very rarely monitoring is required within a week.

Laparoscopic surgery cuts recovery time in half.

If you had to remove one testicle or it was not there at all, the endocrinologist should prescribe hormonal therapy for the correct development of the boy in the male pattern.

Contraindications for surgery

There are few contraindications to orchidopexy. But they are worth considering. Surgery is not recommended forsystemic diseases and bleeding disorders.

Preparation for surgery

Any surgical intervention requires some preparation. Preparation for an orchiopexy is as follows:

• examination by a pediatrician, identification of diseases that are a contraindication to surgery;
• urine and blood test;
• all drugs (including aspirin) that can help thin the blood should be stopped within a week;
• MRI and ultrasound;
• no food for 8-10 hours;
• it's definitely worth having a conversation with an anesthesiologist to eliminate risks during surgery.

Possible complications during surgery

Numerous positive reviews about the operation for cryptorchidism in children make it clear that the procedure is safe. But there are exceptions. In rare cases, possible:

• bleeding;
• infection at incision sites;
• incorrect position of the testicle during surgery;
• scrotum swelling;
• injury to the seminal ducts and blood vessels that provide nutrition to the testicles.

Recovery after surgery

After the operation, the child remains under observation in the hospital for up to three days. In rare cases, a decision is made to stay the patient in the hospital for up to a week. For about a month, outdoor games, sudden movements and heavy lifting are not recommended.

One week and every subsequent month up to six months after the operation, it is necessarysee a doctor.

Prevention

Since the development of cryptorchidism begins in the prenatal period, preventive measures are aimed at the expectant mother:

• must lead a he althy lifestyle;
• try to protect yourself from infectious diseases;
• do not take drugs prohibited during pregnancy;
• keep away from spraying chemicals;
• follow the instructions of the attending physician.

Conclusion

It is very important to notice the absence of a testicle in the scrotum in time, because the longer treatment is not carried out, the less likely it is to maintain childbearing function in adulthood. This is especially true for children with bilateral cryptorchidism. In this case, even after treatment, up to 70% of spermatogenic cells die off. With one-sided - up to 20%. With ectopia, as a rule, the testicle is removed.

If the doctor recommends a surgical method when confirming the diagnosis, there is no need to be afraid. As a rule, children tolerate the operation well, and recovery is fast. But this issue requires a well-coordinated tandem of several specialists - a pediatrician, urologist, endocrinologist.

All reviews of cryptorchidism in children speak of the importance of timely treatment of this pathology.