Cryptorchidism

introduction

There is one hidden behind the seemingly complicated term “cryptorchidism” Abnormal position of the testicleincorrect positioning of the testicle in the body. Originally the "cryptorchidism" describes one undetectable testicle. This is mostly the case when the testicle not fully descended into the scrotum during embryonic development is and remained in the abdomen is. In practice, however, the term cryptorchidism has become a term for all possible positional anomalies of the testicle. A distinction is made between different forms of undescended testicles and also different forms of "Testicular ectopy". While an undescended testicle - as the name suggests - describes an incomplete descent of the testicle from the abdominal cavity, it is called testicular ectopia a deviation from the correct descent route. In the case of a testicular ectopy, for example, the testicle literally descends, but then comes to lie under the skin of the thigh.

to form

There are two major types of abnormalities in the testicle:

• the Undescended testicles

The testicle is originally placed in the abdominal cavity, only from the embryonic phase up to the age of two, does the testicle descend into the scrotum. A non-descent of the testicle is known as undescended testicles. There are in turn different shapes - depending on the place where the testicle finished its descent. A Inguinal testicles describes, for example, a testicle that remained in the inguinal canal is.

As Sliding electrodes is a testicle that can be moved between the scrotum and the inguinal canal by external pressure. Here, too, its original position is the inguinal canal.

At the Pendulum testicles one finds the same phenomenon as with sliding odes, only that the change in position is not due to external pressure, but for example by sexual pathogens he follows.

The last sub-form of the undescended testicle is the Cryptorchidism. As mentioned at the beginning, the cryptorchidism represents a special role, since it actually forms a sub-form, but in urological practice it is synonymous with all forms of Testicular dislocation is used. In the original sense it describes you hidden (Greek "kryptos") Testicleswhich is usually found in the abdomen. It is also a form of undescended testicles.

• the Testicular ectopy

The term Ectopy comes from the Greek of "ectos“ (Outside) and "topos" (of the place). A testicular ectopia is accordingly an "extra-locality" of the testicle. That does not mean much in itself, because an “extra-locality” can in principle be anything. Therefore, one differentiates between several forms of testicular ectopy.

In the "transverse testicular ectopy“The testicle comes to rest in the opposite scrotum. In a scrotum are now two testicles, in the other none at all.

The penile testicular ectopia denotes a Displacement of the testicle into the limb, the perineal testicular ectopia a Relocation to the perineum area. Finally, the testicle can also be found in the subcutaneous tissue of the Thigh come to rest what one calls femoral testicular ectopy designated. In practice, all these forms are often referred to as cryptorchidism for the sake of simplicity. Conversely, cryptorchidism is always present when the testicle is not in its anatomically correct location in the scrotum.

root cause

For a defective testicle - or cryptorchidism - is one Wrong development in embryonic maturation responsible. During the 28th to 32nd week of pregnancy, the testicles usually begin to descend on both sides from the abdomen into the scrotum. The abdominal cavity represents its original location. During fetal and embryonic development, the body grows and stretches, so that various organs - such as the testes - have to "correct" their position. So the testicle descent is a complete natural processwhich, however, can lead to problems for a variety of reasons. If the testicle has not yet descended completely by the end of the 32nd week of pregnancy, this does not require immediate treatment. A descent can bis at the end of the second year of life respectively.

therapy

Therapy for cryptorchidism should be general until the end of the second year of life to be finished. This point in time is seen as the dividing point for the further functionality of the testicle. If cryptorchidism persists after the second year of life, tumorous degeneration and infertility are likely. Until then, however, you can wait to see whether the testicle descends on its own.

Should the Testicles be palpable in its "wrong place", therapy can also be carried out after the third month of life. A Pendulum testicles - a testicle that only moves towards the inguinal canal when sexually aroused - does not have to be treatedas long as it is normally in the scrotum.

Unlike the floating testicle, which can be moved between the inguinal canal and the scrotum, no impaired fertility is to be expected with a pendulum testicle. For all other forms of the Undescended testicles or cryptorchidism, therapy is indicated. This consists primarily of one Hormone Therapy with GnRH. GnRH is an abbreviation for Gonadotropin relasing hormones, that is, one hormone, which is another hormone - namely Releases gonadotropin. Gonadotropin, in turn, is responsible for the sexual development of male (and female) Gonads, and promotes thus that growth, the Weight, and the descent of the testicle into the scrotum. A relatively complicated mechanism, which, after four weeks of treatment, leads relatively elegantly to the descent of the testicle into the scrotum in a third of the cases. Elegant because that GnRH very easily as a nasal spray can be applied and no surgery necessary is.

If there is no success after this hormone therapy, one must, however, be up to the age of 18 months operative fixation of the scrotum in the scrotum. This intervention is also called "Orchidopexy“.

A Hormone therapy is Contraindicated in all forms of testicular ectopia. After all, with testicular ectopia, the problem is not an undescended testicle, which could be combated with the addition of sex hormones. The testicle has descended far enough, but has come to rest in the wrong place. In this case, a dose of GnRH would promote further growth on the perineum, on the limb or - depending on the shape - on the thigh. In these cases the First choice surgical means.

diagnosis

A diagnosis the cryptorchidism can be very simple Scan be asked. Since the child is not yet in a position to provide information about their complaints, the doctor is also dependent on the observations of the parents. In this way, clues for a possible cryptorchidism can also be found in the conversation. Apart from that, the doctor is available based on the Ultrasound an inexpensive and safe method is available to assess the structures in the scrotum. An ultrasound head is placed on the scrotum and, with the help of contact gel, the transmission of ultrasound waves into the testicular tissue is made possible. Due to the different reflection of the ultrasonic waves, the doctor can analyze the conditions in the scrotum. A combination of all three methods greatly facilitates the diagnosis of cryptorchidism.