Endocrinology / / May 15, 2016
Diseases of male genital glands
Despite the fact that various aspects of this problem have long attracted the attention of researchers, terminology issues require some refinement.The most reasonable should be considered as a classification developed by YD Mirlesom.The term "cryptorchidism" recommended to denote all the anomalies of the testicles, in which one or both testicles in the scrotum absent.The author distinguishes between delay and ectopia (incorrectly completed lowering) eggs.
Etiology and pathogenesis of cryptorchidism
etiology has not been established.Local anatomical changes (fibrosis of the plate, seam in the inguinal canal in the area of its external opening), which some authors consider the cause of cryptorchidism, with the same success can be seen as a consequence of it.A more reasonable should consider the views of those authors who in the pathogenesis of cryptorchidism attach importance to a lack of production of gonadotropins and the local changes mentioned above.
The undescended testes such changes occur that lead to a decrease in the production of sex hormones and suppression of spermatogenesis.It is believed that this is due to a higher temperature in the abdomen compared to that available in the scrotum.Moreover, in the scrotum, it can vary depending on the ambient temperature.
a long time believed that because the testicles do not descend, and that they have degenerative changes.Testicular biopsy is widely used as a method of research and was able in this way to establish some regularity.Testicular biopsy is performed as follows: in the testicle area, the poorest vessels scalpel incision is made triangular surface tunica dimensions 3x3 mm, then together with the protruding piece parenchyma tunica is cut with sharp scissors.The wound is sutured testicular tunica catgut.Taken for studying the tissue slice is fixed in 10% formalin and embedded in paraffin.Stained sections performed with hematoxylin-eosin and van Gieson.
Histologically preparations measured the average diameter of the convoluted tubules.The measurement is performed at 20 okulyarmikrometrom tubules of each drug, calculated the standard deviation and the value of the average error of the mean (m) according to the formula (?):
Spermogenez measured by the number of layers of the epithelium, the presence of various forms of cell and sperm.Attention is drawn to the thickness of the stroma, its status, presence or absence of Leydig cells.Age-related histological changes in the undescended testicle compared to the normal testicular micrographs of people of appropriate age, the Chern.
To collect pieces of testicular tissue should not be made a special section, and this manipulation is performed during arhidopeksii operation.
Up to a certain age in most patients the histological structure of undescended testes is no different from the normal structure.Only with the passage of time attacking the phenomenon of sclerosis of the stroma, atrophy of seminiferous epithelium.Undescended testicle retain the normal structure of 5-10 years of age.It is noted that 20% of patients with cryptorchidism have a congenital hypoplasia of the testes.Histological studies conducted by us in 30 patients, also showed that up to 10 years of age histological structure of undescended testicles is not very different from normal.Later there are signs of sclerosis of the stroma, and atrophy zapustevaniya convoluted tubules, discontinuation of differentiation seminiferous epithelium (see Figure).
|Microphotogram eggs inguinal delay patient 9 years.Undifferentiated epithelium of convoluted tubules without zapustevaniya phenomena.Lack sclerosis.Stained with hematoxylin-eosin.Uv.200.|| |
Microphotogram testicular ectopia at the groin in a patient 15 years.Atrophy and zapustevanie tubules.Stained with hematoxylin-eosin.SW, 200.
Clinical observations show that undescended testes are more likely than in the normally arranged develop malignant tumors.Among the observed 115 patients with cryptorchidism tumor undescended testicle was found in 13 patients (11.3%), in 11 of them the testicles are in the abdominal cavity.In one patient, whose operations found rudimentary uterus, she had a tumor both undescended testicles.Less commonly encountered when cryptorchidism and testicular torsion of the spermatic cord torsion.
Thus, on the consequences of cryptorchidism is quite a serious disease.
clinical picture cryptorchidism
Complaints of pain in one or another groin impose less than half of the patients.Usually, the pain associated with the presence of concomitant hernia.The majority of patients noted the absence of one or both testicles in the scrotum.Untreated through adulthood bilateral cryptorchidism patients complain of decreased potency and sterility.
Objective change general depend on the degree of severity of failure of the testes, usually observed in the bilateral cryptorchidism and are in a weak development of secondary sexual characteristics.However, the most frequently encountered unilateral cryptorchidism common phenomenon, as a rule, lacking.
Diagnosis and differential diagnosis of cryptorchidism
On examination revealed the absence of one or both testicles in the scrotum.It is believed that the diagnosis of cryptorchidism is very simple.Often, however, allowed the diagnostic error.To choose the right method of treatment is very important to differentiate between the so-called psevdokriptorhizm from the true, and the delay to distinguish from the inguinal ectopic testis.When the testicles are not palpable abdominal delay.The so-called psevdokriptorhizm explained by increased reflex with m.crenaster.These children are always well developed scrotum, and gentle palpation warm hands usually easily able to bring down the balls to the bottom of it.This condition usually does not require any treatment.
Inguinal ectopia (incorrectly completed lowering) - this is such a malformation where the egg came out of the inguinal canal, wrapped and placed on its front wall.
inguinal ectopic testis
This malformation occurs in 27% of patients with cryptorchidism.On palpation egg rolls easily under the skin of the groin area in two mutually perpendicular directions, and does not escape into the abdominal cavity.Usually the corresponding half scrotum developed satisfactorily.
palpated it more deeply, and often escapes When inguinal retention in the abdominal cavity, as the processus vaginalis of the peritoneum is usually cleft.The corresponding half scrotum usually hypoplastic.
crucial to the success of a variety of age and treatment.Undescended testicle retain the normal structure of up to 10 years of age.
Consequently, before that date, they should be placed in the normal conditions for their development.When the delay of bilateral testicular treatment should start with the use of human chorionic gonadotropin (hCG).And only when there is no effect after two courses of treatment should be to put the indications for surgery.Children from 6 to 10 years are administered by intramuscular injection of 500 IU hCG - 2-3 times a week - 20-30 injections per course of treatment.In the absence of effect of 2-3 months a similar treatment can be repeated.The indications for the cessation of treatment is the appearance of signs of precocious puberty or early differentiation of bone in areas of growth, and the lack of tendency to lowering the testicles after two courses.If patients are treated over the age of 10 years old, the treatment regimen remains the same, but the dose is increased to 1500 units.In other forms of cryptorchidism treatment chorionic gonadotropin is shown only in those patients who, along with cryptorchidism, hypogonadism occurs.At the same time with injections of human chorionic gonadotropin it is quite advisable to appoint a vitamin E 20-40 mg daily for 3-4 months, vitamin A, 50 000 IU for 3-4 months.
- primary testicular failure function
- male gonads.Embryology, anatomy and physiology
- diagnosis and treatment of climacteric neurosis
- menstrual cycle Hormonal disorders
- menstrual cycle Use of estrogen for the treatment of climacteric neurosis
- The use of androgens in the treatment of climacteric neurosis
- Violation of the menstrual cycle disorder monthly rate.Opsomenoreya
- Violation of the menstrual cycle with monthly rhythm disorder.Polimenoreya
- principles of hormone therapy violations
- menstrual Principles of hormonal treatment of dysfunctional uterine bleeding
- Prevention of recurrence of dysfunctional uterine bleeding
- Tumors Leydigovyh cells hilyusa ovarian
up to 6 years of age to carry out treatment impractical because before then there are cases of spontaneous testicular descent and normal structure of their retained up to 10 years.In addition, starting from 6 years of increased reactivity to chorionic gonadotropin;in patients over the age of 15-16 years, the treatment of cryptorchidism hormonal therapy effectively enough.
Patients with unilateral cryptorchidism, testicular ectopia groin, and when combined with a congenital hernia subject exclusively surgical treatment, since they usually are expressed by anatomical changes in the inguinal canal or around the testicle.The optimum age for surgery is 8-9 years.