Can the testicles be recovered after being inserted into the abdomen?

Cryptorchidism is a condition in which one or both testicles do not descend into the scrotum but stay anywhere on the way down. Cryptorchidism occurs when the testicles cannot be found in the scrotum. At this time, B-mode ultrasound can be used to check the location of cryptorchidism and whether there is cryptorchidism in the abdominal cavity. There are mainly the following factors:

(1) Anatomical factors ①During the embryonic stage, the testicular frenulum is short or absent, which does not allow the testicles to descend fully. ②Adhesions occur between the testicular mesentery and the peritoneum, preventing the testicles from moving downward. ③The blood vessels of the testicles develop abnormally, are bent or wrinkled, and are pulled from above to restrict the descent of the testicles. ④The blood vessels of the spermatic cord or the vas deferens are too short. ⑤ If the testicles are too large, the inguinal canal is too tight, or the distal end of the outer ring lacks access to the scrotum, the testicles cannot enter the scrotum. ⑥The scrotum is abnormally developed and the scrotum is too small to accommodate the testicles

(2) Endocrine factors require sufficient motivation for testicular descent, which is to rely on maternal gonadotropins to stimulate fetal testicular interstitial cells to produce androgens , such as ① when the testicle itself is defective, it does not respond to the decline of gonadotropin and cryptorchidism occurs; ② because testicular descent occurs when the concentration of gonadotropin in the blood is very high, so when the maternal gonadotropin is deficient, the testicle will also be caused. Incomplete descent.

(3) Genetic factors Some patients with cryptorchidism have an obvious family history, so genetic factors may be one of the causes of cryptorchidism. There may be other reasons leading to the occurrence of cryptorchidism. It is expected that with the continuous improvement of medical level, these reasons will be clarified one by one, so that effective prevention and treatment methods can be found to prevent the occurrence of this disease.

Overview

Cryptorchidism is the congenital absence of testicles in the scrotum, which includes incomplete testicular descent, testicular ectopy and testicular absence. Among newborn boys, about 4 to 10 boys have incomplete testicles that are not lowered into the scrotum at birth, and continue to decline after birth. By the age of 1 year, the incidence of cryptorchidism is only 1 to 2, and in adults it is about 0.4. There are more unilateral cryptorchidisms than bilateral ones, about 5:1.

Cause

There are two theories for the cause of incomplete testicular descent: 1. Endocrine factors: If maternal chorionic gonadotropin is insufficient or the testicle itself is defective and does not respond to this hormone , often causing incomplete descent of the testicles on both sides. 2. Mechanical factors: such as short spermatic vessels, hypoplasia of the testicular cord or inguinal canal, adhesions between the testis and retroperitoneal tissue, and variations in the cremaster muscle, etc., which hinder testicular descent. This condition often causes unilateral incomplete testicular descent.

Symptoms

Long-term stay of the testicles in an abnormal position can cause adverse consequences:

1. Testicular atrophy: the testicles do not descend into the scrotum. There are only mild tissue changes during the year, but testicular hypoplasia or atrophy will occur after 2 to 5 years of age. Cryptorchidism on both sides can render 90% of patients infertile.

2. Malignant transformation: The risk of malignant transformation of patients with cryptorchidism is 20 to 48 times greater than that of normal testicles in the scrotum; while the risk of malignant transformation of intra-abdominal testicles is five times greater than that of inguinal testicles. Congenital defects of the testicles, abnormal position of the testicles, and high surrounding temperature are the causes of malignant transformation of cryptorchidism.

3. Susceptible to trauma: The testicles are located in the scrotum and have greater mobility, so the chance of trauma is smaller. The testicles located in the groin, when the abdominal muscles contract, the inguinal canal also contracts, and the testicles inside are squeezed. The testicles in the abdominal cavity are also often squeezed by changes in abdominal pressure.

4. Testicular torsion: Testicles with cryptorchidism may have abnormal attachment of the testicular band, cremaster muscle, or testicular sheath, and are prone to testicular torsion.

5. Others: About 65% of patients with cryptorchidism have indirect hernia.

6. An empty scrotum can cause feelings of inferiority, mental depression, and withdrawn temperament.

Examination

Patients with cryptorchidism often come to the doctor because of an empty scrotum and no testicles. There are also people who come to the doctor with the main complaint of "hernia", or who come for examination because of bilateral cryptorchidism or post-marital infertility. The diagnosis is generally not difficult to diagnose. However, attention should be paid to the differentiation between cryptorchidism where the testicles cannot be felt and testicular absence, because the latter does not require surgery.

If the patient has XY chromosome type, serum follicle-stimulating hormone (FSH) is elevated, serum testosterone (T) is reduced, and the testosterone level does not respond to stimulation by chorionic gonadotropin (HCG), then For bilateral testicular absence, surgical exploration is not required.

Unilateral testicular absence is difficult to diagnose before surgery, and hormone tests are normal. Gonadal venography, laparoscopy, B-ultrasound, and CT scan may be helpful in diagnosis, but surgical exploration is still required if necessary.

Treatment

(1) Endocrine treatment: Bilateral cryptorchidism can be treated with chorionic gonadotropin first. Hormone treatment should be carried out before the age of 3 to 5 years old. If hormone treatment is ineffective , it should not be continued or repeated application, and should be changed to surgical treatment.

(2) Surgical treatment: Unilateral cryptorchidism or bilateral cryptorchidism that is ineffective with hormone treatment should be treated surgically.

1. Timing of surgery: It is recommended that testicular fixation be performed at an earlier and earlier age. At present, it is generally believed that it is better to have surgery before the age of 2 years. For low cryptorchidism, surgery can also be performed before the age of 6.

2. Surgical method: Make an oblique incision in the groin to find the testicles, fully free the spermatic cord and vas deferens, and fix the testicles in the scrotum. If bilateral cryptorchidism cannot be fixed in the scrotum, one testicle should be retained and placed under the skin as much as possible to preserve its endocrine function. For unilateral cryptorchidism after puberty, especially high cryptorchidism where the testicle cannot be felt, the testicle should be removed to prevent cancer.

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During the growth process of the fetus, the testicles descend from the retroperitoneal waist. On the way down, the testicles can stay at the retroperitoneum, inguinal canal and scrotal entrance. About 70% of cryptorchidism is in the inguinal canal, and is often accompanied by Have an inguinal hernia. Most occur on the right side, and 10-20% are bilateral.

(1) Clinical manifestations

One or both sides of the scrotum are smaller, and there are no testicles in the scrotum when palpated. The testicles can often be felt in the groin area of ??some patients.

(2) Treatment

① Endocrine therapy: mainly used for bilateral cryptorchid testicles

around 4 years old. Chorionic gonadotropin 1000iu can be administered intramuscularly every 2 days. A course of treatment is 2 weeks, and a course of treatment can be repeated if necessary.

②Surgical treatment: Mainly used for unilateral cryptorchidism, the age is 4-5 years old, orchiopexy is performed, and inguinal hernia is repaired at the same time.

② Cryptorchidism resection: Cryptorchidism should be surgically removed if the testicles are obviously underdeveloped, cannot be moved down and fixed because the spermatic cord or vas deferens are too short, or there is a possibility of malignant transformation.