The undescended testicle is one that has not descended into the purse and stopped at a place the way. When the testicle is absent from the stock exchange but outside the migration route, they say “ectopic”. It affects 1.6 to 9% of newborns but 0.9 to 1.8% of infants 3 months because of a phenomenon of spontaneous reduction the first year. More than one in five premature male cryptorchidism at birth. Cryptorchidism is unilateral (one testicle) in two thirds of cases and bilateral in one third of cases.
The mechanism of migration of the embryonic testis is complex. Located in the thoracolumbar region at 6 th week of embryonic life, germ cells will then begin a process of migration in the abdomen (trans-abdominal stage under the influence of anti-Müllerian hormone and insulin-like hormone-stimulated type 3 HCG and placental fetal pituitary LH), remain at the level of the inguinal canal in the 15 th to 26 thweek of pregnancy, then win the scrotum (testicle sac) at inguinal-scrotal phase (from 26 th to 35 th week of pregnancy). Inguinal-scrotal phase is dependent on androgens.
Under the effect of androgens, genito-femoral nerves will release a peptide which will stimulate the muscles of the scrotum and the dartos gubernaculum to “pull” the testicles. The development of the abdominal muscles and increased intra-abdominal pressure is, itself, help to “push” the testicles into the scrotum. In all these stages may arise problems that will cause a unilateral or bilateral cryptorchidism.
The essential symptom is, by definition, the absence of a testicle (unilateral) or both testicles (bilateral) into the scrotum. Absence is usually detected at birth in the systematic review conducted. In most cases, the testicle is localized in inguinal but in less than 4% of cases, the cryptorchidism is intra-abdominal (later increased risk of cancer).
They are not useful to confirm the diagnosis. In most cases, the testis is palpable groin (near the groin), but in 30% of cases, they are not and other tests will be required to locate the testicle. This will be the role of laparoscopy before surgery.
Indeed, ultrasound is not sufficient to affirm the existence of a testicle on the migration route and the scanner, such as MRI, may miss an intra-abdominal testis. Depending on context, hormone assays and karyotype be performed.
- Mutation of the insulin-like hormone type 3 (see question 2) or its receptor;
- Mutation of the androgen receptor;M
- Mutation of the 5 alpha-reductase type 2;
- Mutation of anti-Müllerian hormone (see question 2) or its type II receptor;
- Cytogenetic abnormalities (Klinefelter syndrome, XX male 46, etc.).
- Multiple malformation syndromes (trisomy 21, Noonan syndrome, Di George syndrome, etc..).
It may be a lack of testis (anorchidie) or vanishing testis (present at the embryonic stage, and then having atrophied). Other causes must be ruled out:
When cryptorchidism is associated with other abnormalities of the external genitalia (especially hypospadias), the risk of sexual ambiguity usually leads to further tests at birth. It also looks for genetic abnormalities when less and more general signs of cryptorchidism (abnormalities of the face, ears, weight, size, etc..).
The two main risks are the risk of infertility and testicular cancer.
The risk of infertility seems moderate if the cryptorchidism is unilateral (one testicle) and operated: the average delay is then natural conception of 11.1 months against 8.8 months for a normal fertile couple. However, the risk is significantly increased when bilateral cryptorchid (both testicles) and if one does not, 89% of patients develop azoospermia. With treatment, this risk is reduced by half.
The risk of cancer of the testis , even placed in the purse, is significantly increased. Especially for intra-abdominal testis or in case of bilateral cryptorchidism .
One must also consider the psychological consequences of cryptorchidism, especially when the testis (eg, an intra-abdominal testis atrophied) had to be removed. A testicular prosthesis can be seen at puberty.
Finally, the risk of torsion of the pedicle of the testis are not negligible.
It involves going down the testicle surgically and fix (orchidopexy), where possible. Controversy persists about the best time to do it. It seems that the testicular damage does appear that from the age of one or two years, also, some argue they expect that age to intervene, which would reduce all the risks of damaging the delicate structures anatomical structures during surgery. However, the testicular lesions are not only the fact of hyperthermia experienced by cryptorchid testes but also, intrinsically, the consequence of abnormalities responsible for cryptorchidism (See Cryptorchidism Causes). Finally, note that the associated abnormalities of the sperm ducts may also have profound effects on fertility that will not correct – even worse! - The surgery itself.
Anyway, the orchidopexy aims to free the testis of the elements that prevent its migration and fix it in a pocket created in the scrotal dartos. It also corrects the hernial orifice, often gaping. When the testicle is in the abdomen, surgical correction is more complex. It is still a residue of testis (that will be taken away), or the testicle is located too high (a two-step procedure is preferable). monitoring (re specialist advice) to puberty and beyond is desirable .
Before resorting to surgery, some recommend trying hormone treatments (beta-HCG or GnRH analogues) to lower the testicle, but many teams have abandoned because of inconsistent results too.
Urological surgery with the diagnosis and treatment of patients congenital, infectious, lithiasis, traumatic and tumor of male and female urinary tracts (kidney, renal pelvis, ureter, bladder, urethra) and those of the male reproductive system (prostate, testis, penis).
Urology is both a surgical specialty (all urologists are surgeons urologists now have complete surgical training) but also because medical supports some patients without the need for surgery (benign prostate, kidney stones, testicular infections).
The study and treatment of male reproductive disorders, erectile dysfunction, ejaculation, fertility is the Andrology which is involved in urology with other specialties (psychiatry, endocrinology, gynecology , etc.)..
The study and treatment of disorders of the urinary tract of children, mostly malformative tumor or infection but also constitute the infant urology. It is exercised by urologists or pediatric surgeons who have acquired a particular skill area and represents a boundary between the two specialties.