Anomalies of testicular
Anomalies of the testicles – Elite Treatment in Europe
Anomalies of the testicles is quite common malformations. Their frequency ranges from 2 to 5% of the children. There are:
- abnormalities of the testicles (anorhizm, monorhizm, poliorhizm)
- structure anomalies (hypoplasia)
- abnormalities of the testicles (cryptorchidism, testicular ectopia).
Anorhizm. Anorhizm – is the absence of both testicles. Usually accompanied by a simultaneous hypoplasia of the epididymis and vas deferens. When this anomaly in a child dramatically reduced the number of male sex hormones, there is no secondary male sex characteristics (eunuchoidism). Surgical treatment of this defect is not possible. It is used hormone replacement therapy.
Monorhizm. When this anomaly is not of one of the testicles. Diagnosis is by ultrasound. Usually the absence of one testicle does not affect the development of the patient and his sexual life, if the function of the remaining testicle retained.
Poliorhizm. In this congenital patient at the same time, there are three or, more rarely, more eggs. Additional undeveloped egg close to the normal testicle. Sometimes an additional egg is found in the pelvis. Surgical treatment. Incremental testicle removed. If it has an appendage and the vas deferens, they are removed together with the egg. Remove the additional egg because it is subject to frequent malignant degeneration.
Hypoplasia of the testis. This anomaly is the structure of the testis. In this case one or both testicles are underdeveloped, reduced in size to 5-7 mm. Bilateral hypoplasia of the testes is accompanied by a hormone deficiency and require hormone replacement therapy.
Cryptorchidism. This is the most common anomaly of the testicles. At the same vice of one or both testicles do not descend into the scrotum during fetal development. The testicle is retained in the abdomen or at the level of the inguinal canal. The frequency of this anomaly of 1 to 5% of all newborn boys. In 10-15% of children with cryptorchidism, especially premature infants, the testicle descends into the scrotum during the first month of life, over the next six months, yet 30% of children on their own testicle descends into the scrotum. Most often, more than half of the right-sided cryptorchidism occurs in 30% of the children left-sided, and in less than 20% found bilateral undescended testes into the scrotum. Cryptorchidism is the true and false.
If false cryptorchidism testis into the scrotum can be derived by palpation, but after awhile it comes back to its original location. Such a situation is possible if the testicle has passed the external opening of the inguinal canal and is located in the inguinal canal at the root of the penis.
In true cryptorchidism the testicle is located in the groin area above the external opening of the inguinal canal or abdomen. Usually, when the true undescended testis cryptorchidism is lagging behind in development, is smaller. If the testicle is located in the abdominal cavity, it is exposed to a higher body temperature (in the abdominal cavity temperature is higher than in the scrotum by 2-3 degrees). In the testis there are degenerative changes, it ceases to perform its functions. If both testicles are located in the abdomen in a child having endocrine disorders associated with decreased production by the testes of male sex hormones. Male genital symptoms develop enough.
The diagnosis of cryptorchidism is set on the basis of inspection, palpation of the scrotum and inguinal canal. Spend radioisotope study, ultrasound and laparoscopic study.
Treatment of cryptorchidism. In true cryptorchidism is the eighth month of life in the undescended testes begin degenerative changes. By the seventh year of life, the egg may stop functioning altogether. Therefore, treatment of cryptorchidism should begin as early as 2-3 years. If there is evidence of changes edokrinnyh appointed hormones (human chorionic gonadotropin). In the absence of the effect of surgical treatment. Surgical treatment is carried out in one or two stages. In carrying out the operation in one stage, the egg is reduced in the scrotum and with a thick silk thread fixed to the inside of the thigh. In carrying out the operation in two stages is reduced testicle into the scrotum through the incision and fixed in the scrotum through the incision to the fascia lata, the incision is sutured to the scrotal skin incision hip. After 2-3 months, the suture is cut and the egg moves into the scrotum. Type of operation is determined at the time of surgery. For timely completion of surgical treatment in terms of three years, the normal testicular function is preserved in more than 85% of cases. At a later surgical treatment of a positive result receive less than half of the patients.
Ectopia testis. When this anomaly of the testicle is not in its usual place. It can be found under the skin of the groin, the thigh, perineum, or in the opposite half of the scrotum. If the egg is in the opposite half of the scrotum, the treatment is not required. In other cases, one-stage operation is performed to move the testicle into the scrotum. Timing of surgical treatment – before the age of six patients. The results of operations are usually good.
Department of Urology Professor GEPELYA – GERMANY
CHILDREN urology and andrology in MOSCOW
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Urology, University Hospital Marburg
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