Cryptorchidism consequences after surgery in children. How is cryptorchidism in a child treated? Do you need an operation? Ontogenesis of internal genital organs in men

Cryptorchidism in children is a certain abnormality in the development of the genitals, which is considered congenital. This disease occurs only in the stronger sex and consists in the fact that one or two testicles do not descend into the scrotum, but remain in the small pelvis or in the inguinal canal.

There are times when the testicles are localized in the thigh area, in the groin, and also in the perineum. According to statistics, in the majority of patients who sought medical help, it was the right testicle that did not descend into the scrotum.

Neonatal disease

In premature boys, cryptorchidism can occur in one in five; in those who were born on time, the pathology is less common: there is only one case for ten newborn boys. In more than half of pathological cases during the first year of a child's life, independent recovery and prolapse of the testicles are observed.

Factors that lead to deviations:

• the presence of physiological or pathological obstacles to the advancement of the testicles;
• taking illegal drugs by the expectant mother during the period of gestation;
• disruption of the endocrinological glands;
• intrauterine infection of the fetus.

Normally, the prolapse of the testicles should occur even inside the womb at 32-38 weeks of gestation.

Types of cryptorchidism

In medical practice, there are three types of this ailment:

• false;
• true;
• ectopia.

With false cryptorchidism, the testicle is not palpable, but from time to time it descends into the scrotum and occupies a normal physiological position. This is due to the periodic tension of the muscles that are responsible for the elevation of the testicle. This happens when the child has strong emotions (fear) or when the body is hypothermic. Often, false cryptorchidism is observed in children under five years of age. The deviation does not need treatment, since the drooping testicles are able to rise independently and fix themselves in the scrotum. In such boys, at the time of puberty, the pathology disappears forever.

True cryptorchidism in children is that the abdominal cavity or groin may be the site of localization of the undescended testicle. The fact that the testicle is located in the groin can be determined by palpation, pressing on the skin of a certain area. When it is in the small pelvis, the palpation method will be uninformative, therefore it would be more reasonable to undergo an ultrasound examination.

Ectopia occurs during the period of intrauterine development of the fetus. Boys' testicles go down, but they do not enter the scrotum, but for various reasons end up in the groin, thigh or abdominal cavity.

In practice, re-elevation of the testicle is sometimes encountered. It occurs due to various injuries or with abnormal development of the spermatic cord, when the already lowered testicles fall into the inguinal or abdominal cavity.

There is unilateral (one testicle did not descend) or bilateral cryptorchidism (two testicles did not descend). Also, the disease can be right-sided and left-sided.

Consequences of cryptorchidism

Many mothers, having heard such a diagnosis, compare it with a sentence and prepare for the worst case scenario. Cryptorchidism in children, surgery, reviews - that's what young parents are most worried about now! An experienced doctor must necessarily reassure parents and inform that this disease, with timely treatment, often does not carry complications, and the reproductive system of the male body will function normally. And also, medical histories in urology indicate that the testicles can rise into the scrotum on their own within a year or two.

For boys' testicles to work well and produce normal sperm counts, they must be at the optimum temperature. It is the scrotum that creates normal thermoregulation; if the testicles are in the abdominal cavity, then the production of sperm is disrupted, their function worsens, which can lead to irreversible consequences. Cryptorchidism is one of the causes of male infertility, loss of fertility. The spermogram in such a patient shows that the total number of spermatozoa is small, and sometimes they are completely absent.

Male oncology

Also, due to improper placement of the testicles, oncology can occur. It is believed that for every third man who has a history of cryptorchidism, the consequences of this seemingly harmless disease can result in cancer. If the disease is not detected on palpation, then this only exacerbates the risks. Therefore, at the slightest suspicion, it is extremely important to identify the pathology and carry out effective treatment (up to surgery) of the child until he is twelve years old.

Testicular torsion

Refers to one of the serious complications of cryptorchidism. During torsion, the boy develops severe pain in the groin area, cyanosis of the scrotum, vomiting, loss of consciousness and hyperthermia. This condition is considered serious and requires immediate hospitalization.

Disease in adulthood

A mature man can also suffer from this condition. Due to the improper production of male sex hormones, an increase in the subcutaneous fat layer occurs, which can lead to a deviation in the functioning of secondary sexual characteristics and is manifested in the following:

• scanty hair on the pubis, groin;
• insufficient facial hair growth;
• low sounding of a male voice.

In addition, advanced cryptorchidism in children very often leads to impotence in adulthood. Also, due to the disease, an inguinal and sometimes an umbilical hernia may occur (depending on the localization of the testicle), which is an equally serious pathology, because at any time there is a danger of pinching. When a hernia is pinched, severe pain in the groin is always observed, the patient needs hospitalization. Due to cryptorchidism, the blood supply is disrupted, which in the future can lead to infertility.

We define the disease ourselves

In the family where the boy was born, parents should definitely make sure that the testicles have descended into the scrotum. It's easy to find out, you just need to feel the scrotum well and make sure that there are two testicles in it - one on the right side, one on the left side. If there is any suspicion, parents should consult a doctor for an examination. Thanks to ultrasound diagnostics, you can find out where the testicle is fixed and, based on this, choose an effective method of treatment.

Examinations that allow you to find out the presence of the disease:

• Ultrasound diagnostics of the small pelvis and scrotum;
• Ultrasound diagnostics of the abdominal organs;
• MRI of the pelvis;
• a blood test for male hormones;
• vasography with the use of a contrast agent (a special substance is injected through the vessels, which is visualized on the apparatus).

As a rule, one ultrasound examination is often enough to diagnose and determine the location of the testicle. But there are times when it is not visible on ultrasound, so you have to connect an examination using MRI or computed tomography. These high-precision technologies will surely find the "lost" testicle. Donating blood for hormones is not an obligatory element in the examination; the doctor prescribes an analysis only in cases where there is a suspicion that the child has a serious hormonal disorder. With some genetic diseases and with anomalies of physiological development, donating blood to determine the level of hormones is mandatory.

Treatment of the disease

Many who are faced with a similar problem are sure that this is a very terrible disease - cryptorchidism in children. Treatment, in their opinion, consists only in surgical intervention. However, this is a misconception, sometimes hormone therapy is used to treat the disease. It is mainly effective at an early age.

A special drug is also prescribed (for example, chorionic gonadotropin or gonadotropin-releasing hormone) twice a week for 4-5 weeks. During the period of taking the medicine, the child sometimes experiences increased growth of pubic hair, a change in its color and slight swelling of the scrotum. However, these signs are acceptable (provided that the dosage is selected correctly) and disappear after the complete withdrawal of the drug. Despite the fact that this method is painless, it has many side effects, therefore, in medicine, an operative method of treatment is most often used.

Cryptorchidism in children, operation: reviews

If up to two years the pathology has not been corrected, then it is proposed to solve the problem surgically, which will allow the testicle to enter the scrotum. The operation of cryptorchidism is called orchiopexy. During the intervention, the doctor lowers the testicles into the scrotum and fixes them so that they do not return to their previous location. In cases in which the testicles are too high, the doctor performs surgery twice with a break of a year and a half.

Procedure for the operation

During surgery, which is performed under general anesthesia, one small incision is made in the groin area. However, it so happens that it is difficult to get to the testicle with the instrument; in this case, a more complex technology is used, step by step. It consists in the fact that the doctor pushes the spermatic cords, blood vessels and only then fixes the testicle. The doctor will evaluate it before moving it into the scrotum. With an obvious underdevelopment of the testicle, it is removed, since it is no longer capable of functioning.

The operation of cryptorchidism refers to surgical procedures of medium complexity, and therefore it should only be performed by a competent and experienced doctor.

On the part of the patient, as a rule, surgery is easily tolerated. Children quickly recover from anesthesia, adapt and are soon discharged home. However, after such an operation, it is recommended to visit an andrologist surgeon every six months and undergo medical examination to prevent complications in the male genital area, especially if the testicle has been removed.

Some parents prefer to deal with this ailment on their own, using the methods of alternative medicine. As many years of practice and medical history in urology have shown, pathology in such cases only progresses. And it so happens that the time when medical intervention could still help is lost. Self-medication for cryptorchidism is contraindicated!

Forecast for cryptorchidism

In order to prevent irreversible consequences, the disease should be detected in a timely manner, a thorough examination and effective treatment should be prescribed. If all medical requirements are fulfilled, then the prognosis is generally favorable. According to statistics, with unilateral treated cryptorchidism, infertility in men occurs in 15-20% of cases, and with bilateral - about 70%.

It is important for parents to identify the presence of a disease in a child, since timely diagnosis and treatment increase the chances of a speedy recovery. If you follow medical recommendations and solve the problem on time (before puberty), then the disease, most likely, will not affect reproductive function in any way.

Cryptorchidism in children is a congenital pathological condition in which the testicles (testicles) are not detected in the scrotum, either on one or both sides. Most often, such an anomaly is diagnosed in newborns or small children and accounts for about 3.5-4% of all childhood diseases.

The testicle remaining in the abdominal or groin area can twist and be injured (the next complications). In addition, prolonged non-descending into the scrotum in the future can lead to a violation of the formation of spermatozoa in it and to further infertility of a man. An inadequate temperature regime causes an increased frequency of oncological changes in undescended testicular tissue (long-term complications). Therefore, the main tactic for the treatment of cryptorchidism is to lower it into the scrotum as early as possible.

The main cause of cryptorchidism is a violation of the process of "descent" of the testicles from the abdominal cavity into the scrotum. During the development of the fetus, the testes are formed along with the urinary organs. It is from the embryonic tissue of the future urinary system that "detachment" and the formation of a ligament that holds the male glands occurs. In the future, this ligament grows intensively and "moves" the male gland along with it. Normally, the "descent" processes described above are carried out either in the last weeks of pregnancy, or within 2-3 months after birth.

However, due to a number of reasons, this movement may not occur. There are 3 groups of factors that disrupt the physiological movement of testicles from the abdominal cavity to the scrotum: mechanical, hormonal and endogenous.

Mechanical factors most often represent any "obstacle" to the advancement of the testicle. As a rule, these are the following conditions:

1. hernia of the inguinal canal, through which, in fact, the glands move to the scrotum;
2. the absence of a ligament holding the testicles, or its adhesion to the peritoneum;
3. pathologically short spermatic cord;
4. pathologically narrow inguinal canal or its underdevelopment;

Among hormonal causes cryptorchidism can be distinguished:

1. a group of lesions of the hypothalamus and pituitary gland;
2. lack of maternal gonadotropic hormone.

In the hypothalamic-pituitary system, a hormone is produced that affects the development and functioning of the reproductive system. With a number of different lesions of this complex (underdevelopment, tumors, circulatory disorders due to injuries), the production of this hormone decreases. As a result of this, the development of both the male glands themselves and the violation of their physiological "descent" are disrupted.

Maternal gonadotropic hormone is involved in the formation of the reproductive system of the fetus at the time of its intrauterine development.

Also, this hormone is one of the main factors that trigger the growth of the inguinal ligament and further movement of the testicle. Under the influence of causal factors that reduce the level of maternal gonadotropin, the physiological processes described above are disrupted. Endogenous factors of cryptorchidism in children include a congenital decrease in the sensitivity of testicular cells to hormones affecting them (especially to maternal gonadotropin).

Classification of cryptorchidism

One of the main classifications of cryptorchidism are: determination of the location of the male gland relative to the path of its "descent" (anatomical classification) and its presence / absence in the scrotum.

During its descent, the testicle may encounter a number of mechanical factors (described above) that prevent it from descending into the scrotum. Because of this, the inguinal ligament that descends it can deviate and travel in a different direction. Similar varieties of cryptorchidism are called ectopia... Usually, the following varieties are distinguished:

• abdominal;
• inguinal;
• pubic;
• femoral;

Fig 1. Testicular ectopia: a- inguinal; b - pubic; in-femoral; g-crotch; d-cross

Cryptorchidism itself can also be classified into:

• abdominal (if the male gland is delayed before entering the inguinal canal, directly in the abdominal cavity)
• inguinal (with a retention of the testicle in the inguinal canal itself)

Fig 2. Cryptorchidism: a - the normal location of the testicle; b - inguinal cryptorchidism; abdominal cryptorchidism(from the textbook "Surgical diseases of childhood, edited by Yu.F. Isakov)

Also allocate false and true forms of cryptorchidism... The true form of undescended testicle involves the absence of a testicle in the scrotum. With a false form, the male gland is palpable, but it can move freely between the scrotum and the inguinal canal. This can be due to:

• large length of the inguinal ligament;
• increased tone of the muscle lifting the testicle;
• the relatively small size of the testicle in relation to the inguinal canal.

In addition, the descent of both one testicle and two at once may be disturbed. Therefore, unilateral and bilateral cryptorchidism in children is distinguished.

Symptoms

Cryptorchidism in children may not manifest itself for a long time. In some cases, boys may complain of aching pains in the groin and lower abdomen. However, they most often occur only in adolescence and in the presence of concomitant influences: constipation, muscle tension, sexual arousal.

Therefore, it is important to carry out prophylactic diagnostics of possible cryptorchidism in boys. As a rule, it consists in a preventive annual examination by a urologist. This allows you to determine the violation of the descent of the testicle into the scrotum as early as possible and prevent the occurrence of a number of complications of cryptorchidism.

Effects

If the testicle does not descend into the scrotum during the first months of a baby's life, it remains either in the abdomen or in the inguinal canal. This arrangement has an adverse effect on the male gland. The temperature in the abdominal cavity or inguinal canal is much higher than that in the scrotum. As a result, in the restrained testicle, the processes of sperm formation and the further reproductive function of a man are disrupted.

In addition, the testicle is quite mobile, as a result of which it can be pinched in the inguinal canal or, if it is abdominal, twisted. As a result, the blood supply is disrupted, which can lead to further death of the ovarian glandular tissue.

Abdominal cryptorchidism is a common cause of testicular cancer. The reason for this complication is also explained by the adverse effects of high temperature in the abdominal cavity, which can change the structure of the testicle and cause its malignancy.

The main risks of cryptorchidism are infertility and ovarian cancer. They develop if this anomaly is not eliminated in childhood.

Diagnostics

The main method for determining the presence or absence of cryptorchidism in a child is palpation of the scrotum. The first palpation is carried out directly in the delivery room and can already provide information about the condition of the testicle. A visual examination of the scrotum is also used: in case of unilateral cryptorchidism, its "flattening" from the side of the missing testicle will be determined. Methods of palpation of the inguinal canal are used, which are used to differentiate abdominal cryptorchidism from inguinal.

In addition to methods of palpation and visual examination of the scrotum, and instrumental research:

• Ultrasound of the scrotum and abdominal cavity;
• Computed tomography or magnetic resonance imaging.

Ultrasound diagnostics allows you to assess the blood flow and structure of an abnormally located testicle. CT and MRI are used if it becomes impossible to identify the testicle using all of the above methods.

With bilateral cryptorchidism, hormonal studies are additionally prescribed.

They allow you to assess the level of your own and maternal gonadotropin, as well as assess the hormonal function of the testes themselves.

Criteria for false and true cryptorchidism

False and true cryptorchidism differ from each other both in their pathogenesis (mechanisms of pathological development) and in treatment methods. False cryptorchidism in children can disappear on its own, and the true one requires surgical treatment. Therefore, it is extremely important to distinguish the diagnostic features of these two conditions, since the choice of treatment tactics will depend on this.

The main differences between false cryptorchidism and true cryptorchidism are:

1. With a false form, the testicle is palpable and most often determined in the inguinal canal, while with a true form, the testicle may not be detected at all:
2. The palpable testicle is easily lowered into the scrotum by hand and remains there.
3. The testicle with false cryptorchidism is of the usual form and corresponds in its palpation characteristics to the unchanged testicle from the opposite side.
4. The parents themselves may note that they observe in the child the periodic disappearance of the testicle from the scrotum, which is accompanied by its flattening from the side of the disappearing testicle.

Treatment

Treatment of cryptorchidism in children can be both conservative and surgical. Conservative treatment consists in taking hormonal drugs that contain maternal gonadotropin and are able to stimulate the independent descent of the testicle into the scrotum. However, this type of treatment for cryptorchidism can be accompanied by a number of adverse reactions associated with the intake of hormones. Therefore, conservative treatment is rarely prescribed and not in all cases.

Surgery is the most common treatment for cryptorchidism. As a rule, the operation to descend the testicle into the scrotum can be performed starting from the 1st year of a child's life with inguinal cryptorchidism. With abdominal undescended testicle, its surgical bringing down can be performed earlier - from the 6th month of the child's life. Such differences in the timing of execution are explained by the fact that the abdominal location of the testicle is more dangerous for its structure and further reproductive function, and therefore it is necessary to perform its reduction as soon as possible. With an inguinal position, the testicle can, in some cases, descend on its own. Therefore, a child with an inguinal form of cryptorchidism is first observed by a urologist for 6-8 months, after which the question of an operation is decided.

With inguinal cryptorchidism, the question of the operation must be resolved at the age of 1.5-2 years of the child.

Before starting surgical treatment, the child undergoes preoperative training, which consists in the appointment of consultations of related specialists to assess the functional state of the body. In addition, a consultation with an anesthesiologist is scheduled to select the appropriate method of anesthesia. After that, the operating doctor determines the type and date of the surgical intervention.

Most often, for the surgical descent of the testicle into the scrotum, an operation called orchiopexy is used. There are one- and two-stage varieties of this operation. When performing a one-stage surgical procedure, the inguinal canal is dissected and the testicle is mechanically brought down into the scrotum. After that, the testicle is fixed to the scrotum and further plastic surgery of the inguinal canal is performed. In a two-stage type of operation, after the prolapse and fixation of the testicle, the scrotum is sutured to the incision in the thigh. In the future, a second surgical operation is performed to remove the formed scrotum and testicle from the femoral fascia.

Thus, a two-stage surgical treatment of cryptorchidism is both longer and rather traumatic for the child's body. In this regard, this technique is used only in case of failures of one-stage orchiopexy and in forms of cryptorchidism, accompanied by underdevelopment of the inguinal canal or scrotum.

Cryptorchidism is a disorder in which one or two testicles do not descend in a timely manner.

The norm is the prolapse of these organs from the period of intrauterine development to 1 year after the birth of the child.

Cryptorchidism in boys is dangerous because exacerbations that occur in the absence of adequate treatment can completely change his life.

... Reasons for development

Often, during the examination of children suffering from cryptorchidism, a number of reasons are revealed that contribute to its development:

• Hormonal imbalance in the mother, during the period of intrauterine development of the child. Usually, this is caused by the pituitary gland in the fetus, a malfunction of the mother's thyroid gland, as well as if she has a disease such as diabetes. However, these violations do not always lead to cryptorchidism, but they are especially dangerous in the last stages of pregnancy.
• Genetics. If the child's closest relatives in the male line had this disorder, then the risk of diagnosing cryptorchidism in him increases several times.
• Anatomical disorders: narrow inguinal passage, insufficient length of the seminal process, insufficient nutrition of the testicle due to deformation of nearby vessels.
• Premature birth. The less weight the baby has, the greater the risk of developing cryptorchidism, especially if its weight does not exceed 1 kg, this is also the reason for multiple pregnancies.
• Gene mutation. This applies to boys with Down's disease, which contributes to the disruption of the development of the anterior abdominal wall.

Cryptorchidism in adults

The causes of this disorder in adults are based on mechanical obstacles that interfere with the descent of the testicle into the scrotum and can be determined visually independently, because photo of cryptorchidism can be found easily on the internet. They are usually divided into three main types:

1. Insufficient development of the vascular pedicle
2. Disruption of the endocrine glands
3. With the fusion of the peritoneum

Despite this, (cryptorchidism in adults) is quite rare and is detected during surgical or urological examination, and the diagnosis is based on the results of ultrasound.

Cryptorchidism is divided into four main types:

• The scrotum is unchanged, functions without failures
• If the boy avoids hypothermia, then the likelihood of spontaneous prolapse of the testicle increases several times.
• Due to the reduced size of the defective testicle, it can move independently, as well as leave the inguinal ring

This subtype of the disorder does not require treatment, because eliminates independently.

1. True... The testicle is located in the abdominal cavity or in the inguinal canal. This type of disease is divided into two subspecies: unilateral cryptorchidism and bilateral . In the first variant, the disorders affect only one testicle, while the bilateral one affects both. Bilateral cryptorchidism is accompanied by other diseases that pose a threat to reproductive capabilities. In the case of the location of the testicle in the abdominal cavity, the diagnosis is carried out using laparoscopy. However, upon visual examination, it can also be easily identified: due to the underdevelopment of the scrotum, its asymmetry is observed. On palpation, the testicle can be easily found if it is located in the abdominal region.
2. Acquired It is a consequence of an injury to the groin area, which provoked the movement of the testicle, as well as prolonged wearing of a bandage after removing a hernia. Can be diagnosed at any age. Treatment of cryptorchidism should be comprehensive, including surgery.

In some reference books on medicine, this disease is divided into left-sided (a defect of the left testicle, which occurs most often, due to the anatomical structure of the body) and right-sided cryptorchidism (a defect in the right testicle).

Consequences of cryptorchidism

Infertility is the most common concomitant disease in patients with cryptorchidism, which occurs in 70% of patients

• Bilateral cryptorchidism (both testicles are affected). It occurs due to violations of the circulatory system, overheating of the inguinal zone, caused by entrapment of the testicles, inactivity. The result will show a low or no sperm count. An operation for cryptorchidism of this type, carried out in boys under the age of one and a half years, will help to avoid this type of exacerbation.
• Testicular cancer. According to statistics, the probability of developing testicular cancer is 50% higher in patients who suffer from cryptorchidism. To avoid this, the testicles should be lowered into the scrotum as early as possible. Often, the tumor does not affect the problematic testicle, but the adjacent, healthy testicle.
• Hormonal malfunction of the testicles. In view of the reduced production of androgens, the growth of secondary sexual characteristics slows down. Overweight appears, and the physique becomes similar to that of a woman. Facial and body hair growth is slowed down or completely reduced.
• Torsion is a violation of blood circulation in a problem testicle and occurs in patients of all ages. It is characterized by pain in the groin area, fever, and vomiting. There is also a blue discoloration of the scrotum.

Cryptorchidism treatment

Treatment of this type of disease should be started as soon as possible after the diagnosis is made, and it is prescribed strictly individually.

There are only two types of treatment: conservative and surgical

1. Conservative type of treatment, includes the intake of hormonal drugs that stimulate the migration of the testicle into the scrotum, as well as the intake of special vitamins. This method is used mainly for the treatment of cryptorchidism in young children (up to 1 year old)
2. Operational type of treatment, requires inguinal cryptorchidism . This type of operation is performed both under general anesthesia and under local anesthesia, during which an incision is made in the groin area by 1.5-2 cm in order to lower the testicle into the scrotum and fix it.

For the treatment of abdominal cryptorchidism, there are two types of surgery: open and laparoscopic

Open operation: An incision is made in the abdomen, the testicle is found, and it is lowered into the scrotum in one or two stages.

Laparoscopic me: one or more punctures are performed on the abdomen, near the testicle, and lowered into the groin. However, in adults or adolescents, testicular removal is often performed. it is no longer viable and is at risk of developing a tumor. Also, during such an operation, it is possible to remove an inguinal hernia.

Patients who have been diagnosed with cryptorchidism should be under constant supervision after the operation, because the risk of testicular cancer is especially high for them.

If by 1-2 years old the boy's testicle has not descended into the scrotum, surgery is necessary. Operation for cryptorchidism in children requires a highly qualified approach and modern equipment. The clinic for pediatric surgery "MedicaMente" in Korolev has all the necessary conditions for such operations

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Cryptorchidism in boys: treatment at Medica Mente

MedicaMente is one of the few medical centers in Moscow specializing in cryptorchid surgery in children. Surgical treatment of cryptorchidism in boys is a complex operation. Not every clinic is ready to take on it. The testicular descent operation requires good technical equipment of the clinic and high skill from a pediatric surgeon. It is important not to damage the testicle and to preserve the boy's reproductive function in the future.

Using modern technologies, doctors of the surgical department of MedicaMente in Korolev perform operations for cryptorchidism in children of varying degrees of complexity. Consultation and surgical treatment are carried out by pediatric urologists-andrologists, doctors of the highest category, candidates of medical sciences. Today they are recognized specialists in the field of pediatric surgery, surgeons with more than 15 years of professional experience, consultants of the leading children's clinical hospitals in Moscow (Filatov Hospital, FMBA of Russia).

If you are faced with a diagnosis of cryptorchidism in your child, we invite you for an in-person consultation with the surgeon of our Center. At the appointment, the doctor will tell you everything about the upcoming treatment of cryptorchidism, the methods of performing the operation, and will guide you on the favorable timing of its implementation.

Cryptorchidism and prolapse of the testes in boys: when to have surgery?

The most suitable age for the surgical treatment of cryptorchidism in a child is 1-2 years. In very rare cases, with the possibility of complications and the risk of trauma to the testicle in the inguinal canal, with cryptorchidism in boys, the operation is carried out up to a year. Operations for secondary cryptorchidism are allowed up to 7 years. It is important to remember that delaying the operation can slow down the child's puberty and increase the risk of developing infertility. Timely surgery prevents potential complications of cryptorchidism: inguinal hernia, testicular torsion, infertility, testicular cancer and psychological problems in adult men.

Cryptorchidism in children: testicular descent surgery

Treatment without pain and fear

The use of minimally invasive surgery can shorten and facilitate the treatment process. Despite the complexity of the operation, cryptorchidism, children easily tolerate surgical treatment, quickly recover from anesthesia. As a rule, the child spends only 1-2 days at the Center. At the same time, there is always the possibility of simultaneously staying in the hospital for one or both parents. Parental presence significantly improves treatment outcomes and helps parents themselves cope better with stress

Comfortable conditions of stay in the clinic

All wards of the hospital are equipped with functional beds, a bathroom, digital TV with a multichannel, an emergency call system for medical personnel. The staff of our clinic makes every effort to make patients feel comfortable. Let's note the level of nursing staff: competence, participation, responsiveness, benevolence, you are always welcomed

Guarantees

We guarantee high quality medical services, an attentive approach and comfortable conditions for each patient. The accumulated experience allows us to achieve positive clinical effects and guarantee the reliability of the operation and its safety.

Cryptorchidism in children: the cost of surgery

If it so happened that the boy did not drop a testicle, and you are wondering "where to have the operation for cryptorchidism in the child?", We suggest that you familiarize yourself with the prices for treatment in our clinic. At your service is the knowledge of our surgeons and their experience in the leading children's surgical hospitals in Moscow, an individual approach and an affordable cost of the operation.

• stationary accommodation 1 day (double room with toilet, TV, multichannel)
• anesthesia: anesthesia device Drager Fabius GS (Germany), anesthetic Sevoran
• local blockade execution - Naropin
• all disposable consumables and instruments
• imposition of an intradermal cosmetic suture
• constant telephone communication with the attending physician
• examination any day at the clinic within 30 days after the operation
• all dressings included

• preoperative examinations and analyzes (can be taken at the clinic at the place of residence, in our Center or any commercial clinic)
• diagnosis and treatment of concomitant diseases and their complications

** Not a public offer agreement. Check the cost of services on the day of your request.

How is the operation going

Despite the complexity of the surgical method, the operation for cryptorchidism, carried out at the Medica Mente clinic, is easily tolerated by patients and has a low likelihood of complications. As a rule, the child spends 1-2 days at the Center.

Preparing for surgery

Before performing an operation to descent the testicle, you must consult a pediatric surgeon, at which you agree on the date of the operation, the necessary preoperative examination. For out-of-town patients, remote consultation by phone is possible. You can make an appointment with a doctor by calling the phone numbers listed on the website or using the electronic registration form on the website. The Center's pediatric surgeons will consider your application, contact you, agree on the time of appointment and surgery, and answer your questions. 2 weeks before the expected date of the operation, it is necessary to undergo an examination (it is possible in the polyclinic at the place of residence). The list of tests will be given by the doctor for consultation. The results of analyzes on readiness must be sent to the Center's e-mail.

Anesthesia (narcosis)

The operation to bring down the testicle is performed on the day the patient arrives at the clinic. The child will be examined by an operating surgeon and an anesthesiologist. The operation will take place under general anesthesia, so the child will not feel or remember anything. We allow one of the parents to accompany the child to the operating room until he falls asleep. As soon as the child is in deep sleep (anesthesia), the anesthesiologist will ask you to leave the operating room. Operations for cryptorchidism in children are performed under mask anesthesia. Sevoran has a pleasant scent and is easily tolerated by young patients. After awakening, anesthesia is removed from the body without a trace, without causing side effects and allergic reactions.

Descent testicle surgery

The degree of complexity of the operation to bring down the testicle and the method of surgical treatment depend on the location of the testicle. With inguinal cryptorchidism, the surgeon makes a small incision in the groin up to 3-4 cm, through which he finds undescended testicles and lowers them into the scrotum, where he fixes them with sutures. In the event that the testicles are located high in the abdominal cavity, the operation is performed in 2 stages with an interval of 6-12 months. In this case, the operation of cryptorchidism is carried out by the method of laparoscopy in order to reduce pain, reduce blood loss.

Postoperative period

Immediately after the operation, the child will be transferred to the recovery room, where he will wake up and immediately see his parents. The child's condition will be monitored by a nurse and a doctor. The length of stay of a child in the Hospital after surgery depends on the child's well-being and the type of surgery. As a rule, the child spends 1-2 days at the Center. Upon discharge, you will receive detailed advice on home recovery and postoperative suture care. The stitches are removed on the 12th day from the day of the operation.

What you need to know

Delay in the implementation of the operation of cryptorchidism can lead to a slowdown in puberty in the child and increase the risks of developing infertility.

1. Up to what age is testicular descent surgery required?

   Age 1-2 years is the most suitable for testicular prolapse surgery in a child. Operations for secondary cryptorchidism are allowed up to 7 years.

2. What tests need to be done for surgery for cryptorchidism?

   General urine test (valid for 10 days) General blood test (valid for 10 days) - platelets, clotting time, bleeding (coagulogram) biochemical blood test: protein, bilirubin, urea, HIV creatinine, test for hepatitis "B" and "C" ( valid for 3 months) blood group, Rh factor ECG with decoding or cardiologist's conclusion (valid for 1 month) pediatrician's conclusion about the possibility of surgery

3. Methods of performing an operation to bring down the testicle

   Two methods of surgical treatment of cryptorchidism: an open method (an incision is made up to 3-4 cm in the groin) or laparoscopic (using punctures).

4. How long does the operation of cryptorchidism in children take?

   The average duration of the operation for cryptorchidism is 35-60 minutes.

5. Postoperative period

   In the first month, it will be necessary to limit physical activity. In some cases, surgical and medical treatment are combined in order to restore the operability of the operated testicle and minimize surgical trauma to the testicle. After the operation, boys must undergo a periodic examination by an andrologist in order to control the function of the operated testicle.

6. Is there a guarantee?

   Yes there is! The guarantee for the operation is 3 years, subject to the recommendations of the surgeon after the operation!

Our doctors

Reception is conducted by children's doctors and surgeons of the Medica Mente center

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He specializes in pediatric surgery and pediatric uro-andrology. Accepts children with urological pathologies, diseases of the scrotum, inflammatory diseases, umbilical and inguinal hernias, treats hydronephrosis, vesicoureteral reflux. He is proficient in the operative methods of treating ...

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She successfully performs complex diagnostics and treatment of andrological and urological diseases in children. To the pediatric urologist, surgeon M.N. Nikitsky is treated by patients with a diagnosis of cryptorchidism, spermatocele, phimosis, hydronephrosis, vesicoureteral reflux, enuresis and others. He has many op ...

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From the moment we learned that our boy had cryptorchidism, we hoped that the testicle would descend by itself, especially since it was very low at the exit from the inguinal canal. but it did not drop in a year or two. we regularly did ultrasound and all hoped for something. at the age of 8, we visited an endocrinologist, who prescribed us hormonal therapy with chorionic gonadotropin, but during this period of time the child began to hurt and we did not even start.

Of course, it was very alarming, but after doing an ultrasound scan in September and realizing that the testicle began to develop a little worse and the blood flow there began to decrease, we decided not to postpone.
our doctor works in the 9th hospital. Speransky, so we set out to do the operation there.

General anesthesia scared me most of all, because my child is allergic, but after consulting with an allergist and anesthesiologist, we relaxed and decided to do as the doctors suggested - mask anesthesia, with the possibility of adding medication through a vein if necessary.

Two weeks before the operation, we passed the necessary tests and made an ECG.

we arrived at the hospital on the day of the operation. the day before, he had dinner at 8 o'clock and before the operation he neither ate nor drank, only at night he kissed his chest a little (we are on GV - in the morning). In a few days I began to tell him what would happen, where we would go, that he would sleep a little there, and the doctor would return his testicle to his place, about the fact that we would need to stay there for a while, etc.

before the operation, we had time to play in the playroom, and at 11 o'clock he was taken for the operation. he was a fine fellow, very well behaved, it was interesting for him to go on a gurney, in an elevator, then he told me that he was given a mask to smell, which "smelled like candy", about the doctor's aunt "in a hat." in general, he was quite adequate to everything that was happening.

Of course, for me this hour was one of the most painful in my life, this feeling of uncertainty was very stressful.

around 12 he was brought to the ward.

and then a rather unexpected thing awaited me: in most Internet articles, magazines, those eyewitness stories that I came across, cryptorchidism is considered a rather simple story, the operation is standard, uncomplicated, after a few hours the child gets up, and generally on the same day , well, the maximum for the next one is released, in some hospitals it is allegedly done as a day hospital. and nowhere did I come across information about how the postoperative period goes if the testicle is fixed to the thigh for a while.

In general, they brought the child sleepy, but with the legs tied in a diaper around the knees and told to watch that the child did not spread his legs in ANY CASE. and that we will lie like this for 5 days (!).

The testicle was lowered and a thread was brought out from there, which was just fixed with a plaster to the leg. (as they explained to me, they fix it or not, it depends on what elements are there - how long the spermatic cord, for example, but everyone who was there with this operation was fixed to everyone)

Since he did not yet control himself, they tied his legs and arms to the bed, which led me to a terrible shock, as a result, after 20 minutes of a child's scream, I untied everything and took him in my arms, trying to keep him strictly horizontal for about 40 minutes. rocked him in her arms. I fell asleep for 2 hours and woke up in an absolutely adequate state - in a good mood, with awakened appetite, told me what he saw and where he was. two hours after the operation, I fed him cookies and gave him a drink, and in the evening he ate a banana and ate some porridge.

You can't sit down, you can't bend your legs, you also had to watch at night. I perked up his swaddling like a small one, only legs, but pretty tight. oddly enough, my child quickly understood everything and did not make unnecessary movements, we played a toy soldier - if I had to run away somewhere for a short time, I told him, lie like a soldier, and gave some toys or postcards with animals from the zoo , or a book, then we are very good. brought a DVD-player to the rescue, watched cartoons.

the main problems were of course with the toilet - to write in a bottle, and to poop with outstretched legs, but they also adapted to this.

GV helped us a lot.

The child endured all the dressings somehow correctly, stoically, he never cried and very well. calmly treated everything.

when on the 6th day these fixing strings were removed, the child could hardly stand on his feet - his legs still remembered for a while how to walk ... the weakness was specific. two days later, the stitches were removed.

the topic was closed and we went home.

Now a month has passed since the operation, the child does not feel any seam, no discomfort, or remembers it. For a couple of weeks after the operation, he certainly was decently capricious, and did not get off his chest, but this also gradually faded away, only night feedings remained.

in general, my conclusions about everything:

1. of course, all children are different, but if it is possible to do this operation, when the child understands at least something and you can agree with him, you have to wait. we performed the operation at 2 years 10 months. and glad we didn't do it sooner. there were children of one year old and two years old - they just cried endlessly from fear and the inability to move, it was impossible to negotiate with them, they did not want to play, they were constantly capricious, they did not eat anything, mothers could not go either to the toilet or to the shower, in general , it was not easy for them ...

2. If possible, you need to have a good idea of ​​what exactly awaits you and, accordingly, prepare for this both morally, in everyday life - what and how much to take. whether the mother will be fed, it is possible / not allowed to diapers, clothes, and also to the smallest detail to talk with both the surgeon and the anesthesiologist, what to expect, what are the possible reactions to this or that drug, what are the complications, etc.

3. take to the hospital some little things that will remind you of the house and toys with which you can play in surgery - what is convenient to wash and dry, books, cartoons, songs, etc. and also take something that will help make life more comfortable - a lamp, for example, we only had an overhead light in the ward, and at night, if the child had to be changed, very good. it was convenient to use it.

if you have any questions, write, I will be happy to answer