Cryptorchidism: symptoms, diagnosis, therapies

What is cryptorchidism?

Cryptorchidism delineates a pathological condition in which one or both testicles are not visible inside the scrotal sac and, in some patients, are not even palpable. As we have analyzed in the discussion of previous articles, cryptorchidism is not only a congenital disease , but it can also exist in a rare, albeit possible, acquired form. In the discussion of this article, we will focus our attention on symptoms of cryptorchidism and possible therapies, useful for the patient's remission from this particular pathological condition.

Symptoms

Cryptorchid disease does not give a particular symptomatology and, generally, does not cause any pain to the patient: so much "it is that we speak of" practically absent subjective symptoms ".

However, when left untreated, cryptorchidism in an advanced stage could generate some problems: among all, the formation of an anomalous mass stands out, which in turn causes difficulty in walking.
The appearance of further more eloquent symptoms, such as torsion of the undescended testicle, is linked to further complications of cryptorchidism.
[adapted from Pediatric surgery. Approach and management of the child with surgical problems by G. B. Paris].
Hypogonadism and impotence represent two other complications that complete the symptomatological picture of cryptorchidism, especially in the case of severity.
Rather than talking about actual symptoms, infertility and the possible neoplastic evolution of the epididymis, which can to derive from cryptorchidism, they should be understood as the most serious complications of the disease.

Diagnosis

As can be guessed, the diagnosis of cryptorchidism is not particularly complicated, all "high: in particular, in cases of unilateral cryptorchidism without hypospadias (abnormal development of the urethra), laboratory tests are not essential, since the doctor is already evinces the patient's disturbance.A different situation occurs, however, in the bilateral or unilateral forms of cryptorchidism with hypospadias, in which the diagnostic laboratory tests, considering the possibility of an "anorchia (absence of both testicles), are almost essential: LH, FSH, karyogram ( representation of the chromosomal set of a cell / individual) and evaluation of testosterone pre / post stimulation with hCG (Human chorionic gonadotropin). [taken from Pediatric surgery. Approach and management of the child with surgical problems by G. B. Paris].

Therapies

Although it does not involve particular symptoms, cryptorchidism cannot and must never be underestimated or minimized: when ignored, in fact, it could cause the lack of development of seminal tissue, therefore a progressive atrophy of the testicle and a poor production of spermatozoa / azoospermia, which inevitably leads to total and irreversible sterility. Strictly speaking, the patient should undergo specific therapies aimed at the descent of the testicle; the therapies are indispensable to avoid damage to the sperm production, since these could start already during infancy, and therefore have repercussions in adulthood. Furthermore, therapeutic strategies against cryptorchidism are also considered for the prophylaxis of neoplasms at the genital level.
It should be remembered that in approximately 75% of children with unilateral cryptorchidism, the retracted testicle tends to descend spontaneously inside the scrotal sac within the second year of life, without the need for surgery or hormonal administration. Therefore, the therapeutic process should never be undertaken before 6/12 months, to be completed no later than 18-24 months of life.
Let us now see in detail what the various therapies aimed at redeeming the patient from cryptorchidism consist of:

• in the event that the testicle has not already descended spontaneously within the second year of life, the little patient is generally subjected to medical therapy (administration of gonadotropins): hormonal therapy is aimed at the early reestablishment of the testicle inside the pouch For those children suffering from cryptorchidism, the administration of gonadotropins within the second year of life is essential: in fact, the alterations of the seminiferous cells in the testicle appear very early, therefore postponing the therapy, the risk of repercussions during age adult increases enormously.
• If hormonal administration is not sufficient or ineffective, a surgical therapy known as orchiopexy should be used, in which the retracted testicle, or both, are surgically fixed inside the scrotal bursa.
• When therapeutic strategies are undertaken too late, the undescended testicle could undergo neoplasms: in such situations, the removal of the diseased gonad is recommended.

Reflections

When cryptorchidism is underestimated, and due attention is not paid to the affected child, during adulthood the affected child may complain of fertility problems. not because it is not treated, but because it is treated too late. It is shameful that these errors that affect the patient's future life are still so frequent nowadays. The medical profession, therefore, should be more aware of this: cryptorchidism is a problematic pathological condition that, when left untreated, could cause the patient's fertility is at serious risk, irreversibly.

Other articles on "Cryptorchidism: Symptoms, Diagnosis, Therapies"

1. Cryptorchidism: causes and complications
2. Cryptorchidism
3. Cryptorchidism: summary table