Undescended testicle

Undescended testicle

Description undescended testicle

Is the most common congenital malformation of the male reproductive system, occurs in 30% ofpreterm infants, roughly in about 3-4% of full-term boys born in the time and over one year in the life of this defect, we were replaced by 0.8 to 1.8% of boys. The process of development of male gonads is quite complex and vary over time as the size and location. In human embryos, which in their genetic makeup have a Y chromosome are usually developed testicles under the influence of a number of genes whose activity must be precisely coordinated. In the fifth week after fertilization with embryo formed the foundations of the gonads, which are the same for both sexes. Only under the influence of testosterone, in the presence of the Y chromosome, the gland begins to transform either the male or female gonads. Do gonads during the sixth week vcestovávají along prvopohlavní initial gut cells settle in the gland and either give rise to eggs (oocytes) or progenitor cells, from which during the continuous division and maturation occur in the male sperm throughout their lives.Fundamentals gonads are stored in the posterior abdominal wall and in both men and in women undergoing descent. For women end his career in a small pan as the ovaries (ovarian cancer) and men continue inguinal canal towards cutaneous mound from which the woman formed labia and can form the scrotum (scrotum), the definitive site for testicle. For proper maturation of sperm determines the temperature of 32 degrees Celsius, namely 5 degrees lower than in a small pan, so it is necessary descent. Tanning channels creates a path for the descent of the testicles from the abdominal position of the front wall of the abdomen to the scrotum. Construction of the abdominal wall, however, is not uniform, but consists of several different layers which, during the descent of the testis pushes ahead and all these layers of packaging testis then form and are located in the scrotum. Abdominal wall from inside to outside comprises peritoneum, the thin membrane lining the abdominal cavity of the package rectus abdominis muscle, the oblique abdominal muscle, a subcutaneous fat and skin. In addition to the skin and subcutaneous fat remaining layers of the abdominal wall forms the contents of the scrotum as seed ligament.

The fact that at birth the doctor scrotal testes Nehme’s no reason to panic. In most cases, testicle descend into the scrotum to the first year of life. Cryptorchidism may be unilateral or bilateral.In the first six months of life, the state monitors if spontaneous descent does not happen, it isnecessary to intervene medically. At the end of the first year already in histological sections we can reach pathological changes in terms of reducing the number of cells and a cell volume reduction and after the first year of life is spontaneous descent unlikely. Treatment should be started as early as after 10 months and two years and a maximum of a boy have both testicles at the right place.For the cause is considered to be either mechanical obstacle in the path of descent (inguinal hernia, inguinal canal or narrow) or impaired hormonal signaling from the brain to gonádám andinsufficient levels of testosterone, which is decisive for the descent. Testicle may be retained either in the abdomen in the inguinal canal or above the scrotum.

Symptoms undescended testicle

They are simple – in short, the bag is not palpable skrotálním no content. Child medical check-up in a warm room always in the presence of a parent. Vyštetřit boy must be lying, and sitting cross-legged when the maximum relaxation of the muscles of the abdominal wall. When palpable testicle, it is necessary to clarify its position either ultrasonographic examination or magnetic resonance imaging, which can be a problem in order to maintain the child calmly during vyštření, sometimes chosen general anesthesia. Unfortunately, MR does not show where the testicle retained.When suspected retention in the abdominal cavity is preferable to use a laparoscopic approach when, during one anaestezie performs both finding and surgical correction. The problem is that this operation is necessary to have a special miniatiruzovaný laparoscopic set, which only has a few places.

Treatment of undescended testicle

It is multidisciplinary and cooperate in the pediatricians, chi endocrinologists, urologists and surgeons. Treatment is either conservative or surgical.

Conservative treatment is selected at the impacted testis without evidence of mechanical obstruction and gliding testicle, located outside the scrotum. Are applied hormones (human chorionic gonadotropin or hCG synthetic hormone stimulating endocrine axis hypothalamus – hypophysis – gonad ALH-RH). hCG is preferred Kuli his precise dosing, lower cost and higher levels of testosterone. On the opposite side stands intravenous and relatively frequent side effects even when followed correctly dosing as erections, increased pigmentation of the scrotum and penis growth. ALH-RH has the advantage that the muse applied as a nasal decongestant and is absorbed by the mucous membrane, the disadvantage is inaccurate dosing and the relatively high cost and not always good efficiencies testosterone level is not as high as we need. Good results are obtained by combined treatment with both hormones and success in descent is around 83%.

The surgical approach is chosen for all types of retention, where the obstacle is detected in the glide path and wherever hormonal treatment has been unsuccessful. The procedure is performed by experienced children’s urologist or surgeon and success is around 80%. The most serious complication is poopearční testicular atrophy due to damage to the blood supply. The surgeon selects either the traditional way using a scalpel or laparoscopic.

How can I help myself

Help is only a medical.

Complications undescended testicle

Complications are unfavorable conditions for the maturation of sperm and also a higher incidence of testicular cancer. If they remain both testicles in the abdomen or near the abdominal cavity, they ripen and the affected individual is then sterile. If action is taken within two years of age, then it is retained testicle irretrievably lost is not working and what’s worse, similar regressive changes such as in undescended testes, are detected in the healthy and descended. The reasons are antibodies directed against tissue retained testicle, which kills many of testis tissue physiologically stored. Men with unilateral retention are infertile at 40%, then both sides up to 70%. A tumor which is retained testicle risk to 50 times more than descended is seminoma. Fortunately, the tumor is sensitive to radiotherapy treatment and is well treatable.

Other names: Cryptorchid, retention testicle

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