How to examine and treat cryptorchidism in children?

The occurrence of cryptorchidism in children not only causes problems with the child's reproductive system, but also affects the child's puberty development. Severe cases can lead to a hollow scrotum in the child and even affect the normal future reproductive function. Therefore, after the onset of cryptorchidism in children, parents need to take their children to the hospital as soon as possible for relevant diagnosis and identification, and carry out certain effective treatments to prevent the disease from worsening and endangering the child's future health.

diagnosis

The diagnosis is not difficult. Physical examination shows that the scrotum on the affected side is flat, and the scrotum on both sides is poorly developed. During palpation, the child's scrotum is empty and there are no testicles. About 80% of the hidden testicles can be felt in the inguinal canal area. There is a sense of distension and pain when pressed, and the testicles are highly mobile and cannot be pushed into the scrotum.

Differential Diagnosis

It should be differentiated from testicular agenesis, ectopic testis, and retractile testis. In children, because the levator testis reflex is relatively active, when exposed to certain stimuli, such as cold or fright, the levator testis contracts and can lift the testicles originally located in the scrotum to the proximal end of the scrotum or even into the inguinal canal. The clinical manifestations are quite similar to cryptorchidism, but these testicles are easily pushed back into the scrotum and stay in the scrotum, so they are not cryptorchidism.

Some testicles are difficult to palpate, but this does not mean that all of them are located in the abdomen. During surgery, about 80% of the unpalpable testicles can be found in the inguinal canal or near the internal ring, while the remaining 20% ​​cannot be found even after surgical exploration.

If no testicle is found on one side, it is called monotestis or unilateral testicular agenesis, and the incidence rate accounts for 3% to 5% of surgical exploration of cryptorchidism, and about 1 in 5,000 men has unilateral testicular agenesis. If no testicle is found in both sides of the cryptorchidism after exploration, it is called atestis, and there is only 1 case in about 20,000 men. For cryptorchidism that cannot be touched, there is still no satisfactory method to determine the presence or location of the testicle before surgery.

Ultrasound, CT and MRI examinations are often difficult to obtain satisfactory results due to the influence of intestinal gas. For those whose testicles cannot be felt on both sides, a chromosome examination should be performed depending on the condition of the external genitalia, and an HCG stimulation test can be used to preliminarily determine the presence or absence of testicles. However, surgical exploration is the only reliable method.