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The cryptorchism is the state characteristic of a male in the presence of which one or both small egg are not in a scrotum. In the course of pre-natal development testicles at the boy are located in an abdominal cavity. At normal fetation in a definite time before childbirth testicles at the boy fall to a scrotum. Therefore at the full-term healthy kid is at once after the birth or soon after the delivery testicles are already defined in a scrotum. The word "cryptorchism" happens from Greek and is translated as "the hidden testicles". At this phenomenon testicles can be located in the inguinal channel, in an abdominal cavity. Also there can be their wrong lowering when the small egg after an exit from the inguinal channel begins to fall not in the necessary direction and as a result it appears or in a groin under skin, or on a hip, in a crotch or a pubis. In view of features of a structure of a body of the person cases of manifestation of a right-hand cryptorchism are more often fixed.
It agrees with modern statistical data, a small egg in a scrotum are absent at 2 — 4% of the children born full-term at 15 — 30% of premature kids and 1% of children at the age of 1 year. Approximately in 60% of cases the palpation of that small egg which fell to a scrotum is possible. And doctors diagnose a bilateral cryptorchism for ten percent of children. Also seldom cases of a monorchism or an anorchism, that is lack of one or both testicles occur at the child.
In the course of male pre-natal fetation its testicles at first are put in an abdominal cavity. In case of the correct laying of a sex of future child and his subsequent development without pathologies development of testicles and their subsequent lowering in a scrotum happens from sixth month till birth till sixth week of life of the kid after the birth. In certain cases, depending on genetic features, this process can last to one-year-old age of the child.
Cause of infringement of this process it becomes frequent chromosomal pathology which arises owing to external influences of the chemicals transferred the pregnant woman of viral diseases (in this case toxoplasmosis, flu, a rubella or venereal diseases are extremely undesirable). Also emergence of a hormonal imbalance both at mother, and at a fruit can provoke development of a cryptorchism. The cryptorchism which is considered a symptom of a delay of pre-natal development in certain cases can be followed also by other inborn pathologies. So, at the child the expanded nose bridge, existence of displastichny auricles, pathologies of a backbone and a thorax, malocclusion and an atypical shape of a skull, umbilical or inguinal hernia can be observed.
Also the use by the pregnant woman of some anesthetics can serve as the reason of the subsequent development of a cryptorchism. Treatment by aspirin, an ibuprofen, paracetamol is extremely undesirable. Especially big risk makes reception of at the same time two specified drugs. So, according to researches, reception of two such medicines at the same time increases probability of the birth of the child sick with a cryptorchism, by sixteen times.
More often the cryptorchism is shown at children who were born with a low weight, and also at babies from twin, triplets.
Types of a cryptorchism
At a true cryptorchism the following features are observed: in the course of bringing down by a hand the small egg cannot be moved to a scrotum. In this case the small egg is in a groin, the inguinal channel, an abdominal cavity, above or in a middle part of a scrotum. This disease is treated by means of a surgery.
At a false cryptorchism it is possible to reduce a small egg in a scrotum, regardless of where it is located. Similar pathology meets very often, and too strong tone of a muscle which is responsible for a small egg raising is its reason. At the child in the first months of life this muscle is not reduced in general, at the same time by two years its tone becomes higher, and to eight-year age of the child it is maximum.
At a state which is called a small egg ectopia it is found in a crotch, on a hip, in a penis root, in a groin. In that case the small egg cannot be reduced in a scrotum.
In some cases the small egg which already fell to a scrotum is displaced because of too slow growth of a seed cord.
Diagnosis of a cryptorchism
In time to diagnose and afterwards to cure a disease, it is necessary to conduct careful research at once after the child's birth. It is necessary to conduct this examination in the warm room. The doctor holds with fingers of one hand the child's scrotum, and other hand runs a palpation. In the absence of a small egg in a scrotum the pakhovy channel is palpated. At detection of a small egg in the inguinal channel the specialist tries to reduce it in a scrotum. In this case differential diagnosis between a cryptorchism true and false is rather just carried out.
In the course of diagnosis of a cryptorchism MRT or ultrasonography of an abdominal cavity, and also a small pelvis is also applied.
For determination of lack of one small egg (monorchism) or total absence of testicles in general, it is necessary to conduct special research which is called a contrast vazografiya. Its essence consists that enter a contrast agent then the picture is made into vessels. It is easy to define a small egg which is in an abdominal cavity and is not probed during a palpation by such research.
Complications of a cryptorchism
Today by researches it is proved that at not omission of testicles in them there are morphological changes in the period of fetation vnutriutrobno. So, special temperature conditions are necessary for a normal spermatogenesis (temperature has to be 1,5 — 2,5 °C lower, than in an abdominal cavity). Such conditions are provided in a scrotum. Respectively, the above there is in an abdominal cavity a small egg, the more it is influenced by high temperature, and, respectively, reproductive function suffers.
Over time there are also disturbances of androgenic function. In view of pathological production of hormones boys already in the childhood suffer from excess weight, their secondary sexual characteristics do not develop in time. So, the beard and moustaches very slowly grows, very weak pilosis in a groin is observed, there is high a voice. As a result such child grows up effeminate, and later at him impotence can develop.
Specialists note that often at not omission of testicles at the patient also umbilical or inguinal hernia is observed. In the presence of that pathology the patient has to see immediately a doctor for carrying out surgical intervention. To patients who suffer from a bilateral cryptorchism, as a rule, diagnose man's infertility: only in 30% patients with this pathology are fertile.
Much higher is also the risk of malignant regeneration of the neostarted-up small egg. The most dangerous complication which can arise at similar pathology is a seminoma (a small egg tumor). Also as complications small egg torsion, a small egg injury is possible.
Treatment of a cryptorchism
If to two-year age at the child the small egg did not fall to a scrotum, then carrying out surgical intervention is required. When carrying out operation approximately in half of cases specialists define that the small egg remained in not changed look. The orkhipeksiya is in that case applied. In other cases doctors do not find a small egg at all or delete it in view of the changes of physiological character which happened in it.
If to carry out an orkhipeksiya at early age, then this operation helps to prevent infertility, to correct the inguinal hernias which are very often accompanying a cryptorchism, to prevent injuries and torsion of a small egg at the active child. In time the performed operation will help to prevent disturbances of mental character at more mature age, and also to considerably reduce risk of malignant regeneration. The most optimum age for carrying out such operation is the age of 12-18 months. As a rule, operation takes place without complications, and the child later is written out several days from a hospital.
Practices at treatment of a cryptorchism also hormonal therapy, however it is applied only at a false cryptorchism. Appoint a course of treatment hormones after the child is six months old. Sometimes carrying out hormonal therapy is necessary also before operation.
Prevention of a cryptorchism
Today it is not known of direct methods of prevention of this disease. However the risk of development of a cryptorchism is reduced by thorough training and planning of future pregnancy. So, it is necessary to cure completely all chronic infectious illnesses, to avoid stressful situations and heavy exercise stresses. It is important not to contact to dangerous chemicals in the first months of pregnancy at laying of bodies of future child. It is not necessary to use non-narcotic means with the anesthetizing influence.
Section: Andrology (Man's diseases)