In clinical practice, infants and children often seek medical consultation with their family members. What disease is it that the patient's scrotum is empty and the testicles cannot be felt? How should it be treated? When is the best time for treatment?
In fact, after birth, the bilateral testicles should be symmetrically present in the scrotum. If the scrotum is found to be empty and the testicles cannot be touched, a diagnosis of cryptorchidism can be made by a specialist's physical examination or auxiliary examination that the testicles are located in other parts of the body.
1、 What is cryptorchidism? Cryptorchidism is a disease in which one or both testicles fail to descend into the same scrotum during fetal development due to the failure of the testicles to migrate along the peritoneal sheath process through the inguinal canal. Simply put, the testicles did not descend into the scrotum and did not appear in their intended location, but rather in other parts.
2、 Classification of cryptorchidism
1. According to the location of ectopic testicles, cryptorchidism can be divided into upper scrotal cryptorchidism, inguinal cryptorchidism, and intra-abdominal cryptorchidism.
2. According to whether the ectopic testicle can be touched, cryptorchidism is divided into palpable cryptorchidism (about 80%) and non palpable cryptorchidism (about 20%). Most cryptorchidism is located in the inguinal region, while others may be located in other areas such as the retroperitoneum.
3、 The most common clinical manifestations of cryptorchidism are poor scrotal development and empty scrotum on the affected side. If both testicles cannot be touched and accompanied by a small penis and hypospadias, it may be a hermaphroditism.
4、 Auxiliary examination for diagnosing cryptorchidism
1. Ultrasound, due to its non invasiveness, low cost, and simplicity, can be used as the preferred routine examination for preliminary and definitive diagnosis.
2.CT、 Magnetic resonance imaging can be used as a supplementary examination to ultrasound examination to further clarify the diagnosis and location of cryptorchidism.
3. hCG stimulation test, the main purpose of which is to diagnose epididymitis and avoid unnecessary surgery.
If the imaging examination does not detect the testicles, surgical exploration is still needed. Laparoscopic exploration is the gold standard for diagnosing intangible cryptorchidism, and treatment can also be performed while locating it.
5、 The treatment method for cryptorchidism
1. Hormone therapy The timing of hormone therapy should be between 6-10 months after birth. It is worth noting that there is currently no unified opinion on this treatment plan both domestically and internationally, and there is controversy surrounding the treatment.
Surgical treatment is currently the preferred treatment method. The specific surgical method mainly depends on the location of the cryptorchidism, the age of the patient, and the development of the cryptorchidism.
6、 The prognosis of cryptorchidism surgery and follow-up precautions
It is worth noting that the prognosis of children with cryptorchidism mainly involves fertility and testicular malignancy. Children with unilateral cryptorchidism who receive formal treatment do not have significantly reduced fertility in adulthood compared to normal individuals; Children with bilateral cryptorchidism have significantly reduced fertility in adulthood compared to those with unilateral cryptorchidism and normal individuals. About 10% of testicular tumors are caused by cryptorchidism. The incidence rate of testicular tumors in men with cryptorchidism is 40 times higher than that in the general population, most of which occur after the age of 30, and rarely before puberty. Regular follow-up visits should be conducted after cryptorchidism surgery to detect early signs of testicular atrophy, retraction, and malignancy. The follow-up methods mainly include physical examination, color ultrasound, and if necessary, tumor marker examination.
Conclusion: Generally, males have their testicles descend into the scrotum on their own after birth. If the descent is slow, it is usually completed within 6 months at the latest, and the possibility of further descent gradually decreases thereafter. By the age of 1, it is almost impossible for the testicles to descend on their own. Delayed treatment can affect the generation of sperm, hormone secretion, and the occurrence of testicular tumors in adult patients.
The definitive treatment for cryptorchidism should be completed between 6-12 months after birth, with a maximum recommended completion before 18 months. In addition to the physical examination by the doctor at birth, parents often have the longest exposure to male infants and observe them the most carefully. Therefore, it is recommended that parents gently touch the scrotum shortly after the birth of male infants to check for emptiness. If any problems are found, they can promptly seek further physical examination and color ultrasound assisted examination from specialized doctors. They should not be careless and miss the best treatment time.