Abnormal position of the testicle
| Classification according to ICD-10 | |
|---|---|
| Q53.0 | Testicular ectopy |
| Q53.1 | Nondescensus testis, unilateral |
| Q53.2 | Nondescensus testis, bilateral |
| Q53.9 | Cryptorchidism without further details |
| ICD-10 online (WHO version 2019) | |
The position of a testicle that is temporarily or permanently outside the scrotum is referred to as an abnormal position of the testicle or testicular dystopia (clinical: aberratio testis) . The cause is disturbed testicular descent ( Maldescensus testis ). The clinical picture of the missing or delayed descent of the testes into the scrotum is called cryptorchidism . Testicular torsion (twisting of a testicle) is not a positional anomaly in this sense .
The importance of early detection and treatment follows from the fact that (in addition to the Hodendystopien varicocele ) the most common causes of subsequent fertility disorders in men as well as the only secure cause for the occurrence of malignant testicular tumors are.
Basics
Since the testicle and the ovary arise from a common gonadal anlage retroperitoneally at the level of the kidneys , both testes have to undertake a “migration” from the place of primary formation to the corresponding scrotum compartment of the scrotum, the so-called testicular descent (descent testis ). It begins in humans from the 5th week of embryo.
Successful descent into the scrotum (scrotum) is one of the signs of maturity of the newborn in humans .
There is a belief that taking analgesics during pregnancy may increase the risk of undescended testicles.
frequency
About 3–6% of mature male newborns and about 30% of premature babies (but 100% of all male premature babies with a birth weight of less than 900 grams) still have a unilateral or bilateral positional abnormality of the testicle. After the end of the first year of life, the incidence fell to approx. 0.7%.
In some other mammals, however, testicular descent may not be completed until after birth, such as in horses or dogs , or may not take place until puberty ( rodents , rabbits ).
The prevalence of anomalies in the position of the testicle in domestic dogs is between 0.8 and 10%, with only one testicle being affected in three quarters of the cases. Breed predispositions are present in Toy Poodles , Dachshunds , Yorkshire Terriers , Chihuahuas , Maltese , Pekingese , Miniature Schnauzers , Cocker Spaniels and Boxers .
to form
The location anomalies of the testicle can be divided into two groups. The undescended testicle ( testicular retention ) is a lack of or incomplete descent of the testicle, the testicular ectopy a deviation from the specified path.
Undescended testicles
According to the end of the migration, one differentiates:
- Cryptorchidism : According to the Greek meaning of kryptos (hidden), the testicle cannot be found. It is usually in the abdomen - retentio testis abdominalis or nondescensus testis ("abdominal testicle "). A missing testicular system, the anorchy , must be distinguished from this. In urological practice, however, the term is often broadly defined and used for all abnormalities in which the testicle is not mainly found in the scrotum.
- Inguinal testicles: The descent of the testicle from the abdominal cavity has come to a standstill in the inguinal canal - retentio testis inguinalis
- Sliding scrotum : The testicle can be moved into the scrotum by applying gentle pressure, but immediately resumes its original position in the inguinal canal due to the spermatic cord being too short .
- Pendulum testes , hiking testes : The testis is located, for example during sexual arousal (see cremasteric ) alternately in the inguinal canal and in the scrotum. This generally does not require treatment and does not normally pose a threat to fertility on its own.
Testicular ectopy
The testicular ectopy or ectopia testis is divided into different forms according to the location of the testicle:
- Femoral testicular ectopia : The testicle comes to lie under the skin in the area of the thigh ( femur )
- perineal testicular ectopia : position of the testicle in the area of the perineum ( perineum )
- penile testicular ectopia : displacement of a testicle in the area of the penile shaft
- transverse testicular ectopia : displacement of a testicle into the mutual scrotal compartment
Diagnosis
The diagnosis is carried out through inspection, two-handed palpation , ultrasound examination and often supplemented by laparoscopy ( laparoscopy ). The computed tomography and magnetic resonance imaging play only a minor role. In the case of testes that cannot be visualized by imaging diagnostics, a search for functional testicular tissue should be carried out by determining testosterone , FSH and LH levels. In veterinary medicine, the Leydig cell stimulation test is mainly carried out.
consequences
The most important medical consequences of the various positional anomalies are the risk of developing malignant testicular tumors and the resulting reproductive disorder ( impotentia generandi ).
Malignant degeneration
Without appropriate therapy, the risk of developing a testicular tumor is 32 times higher than with normally descended testicles, but overall it depends on the time of the operation and the height at which the migration stopped:
- if the testicles remain in the abdomen, the risk of degeneration is 5–10%
- in inguinal testicles 1–2%
In domestic dogs , cryptorchidism also represents an increased risk of testicular tumors, but with unilateral cryptorchidism there is no increased tumor risk for the testicles in the scrotum.
Fertility disorder
According to the WHO (1987), in a fifth of the cases of unfulfilled desire to have children, the sole cause is a man's fertility disorder, whereby all positional anomalies of the testicle together (together with the so-called varicocele ) are probably the most common cause. However, really meaningful studies on fertility disorders are in principle difficult to carry out. a. because only the paternity test brings clarity ( pater semper incertus ). Even after timely orchidopexy , reduced fertility is the main complication of primary cryptorchidism. The neoadjuvant GnRH treatment improves the fertility index of primarily cryptorectic children.
therapy
In the first six months of life, the course is awaited and checked. If the testicle is not permanently palpable in the scrotum by then, hormone therapy, as the doctor Bernhard Schapiro first introduced it in 1929 with anterior pituitary hormone, can be administered with gonadoliberin for four weeks, followed by β-hCG for three weeks (both available as nasal sprays ), which should promote the spontaneous descent of the testicle and stimulate the maturation of the germ cells. If this therapy is unsuccessful, surgical fixation of the testicles in the scrotum ( orchidopexy ) is recommended . Both open surgery and surgery via laparoscopy are used to surgically correct a positional anomaly of the testes in infants . The second has proven itself through its minimally invasive damage to the tissue, which shortens the healing process. Although the timing of the operation is the subject of discussion, the current opinion tends towards the conclusion that the treatment should be completed at the age of one. Likewise, the importance of hormone therapy after surgery to counteract consequential damage has not yet been clearly clarified. The success of the therapy requires regular monitoring, as recurrences can occur.
In cryptorchid domestic dogs, the removal of the testicles is the most common procedure - all other measures promote further breeding with affected animals and should therefore be viewed critically. The repeated administration of hCG or buserelin promotes testicular descent if the treatment is started before the fourth month of life. The sooner the treatment is started, the better the success of the treatment. Orchidopexy is only useful with simultaneous vasectomy to rule out further breeding.
Names for animals
Affected pigs are called "internal boar". The term "inner stallion" is used for horses.
literature
- S2k guideline undescended testicles - Maldeszensus testis of the German Society for Pediatric Surgery (DGKCH). In: AWMF online (as of 2013)
Individual evidence
- ↑ Aberratio testis. In: Pschyrembel Dictionary Sexuality. Walter de Gruyter, Berlin 2003, ISBN 3-11-016965-7 , p. 1.
- ↑ Ch. Clemm, M. Busch, A. Gerl, N. Schmeller, M. Weiss: Testicular tumors. ( Memento from October 9, 2007 in the Internet Archive ) Salzburg State Hospital.
- ↑ Analgesics during pregnancy promote cryptorchidism. In: Deutsches Ärzteblatt . March 25, 2010.
- ↑ a b c d Sandra Goericke-Pesch: Cryptorchidism in dogs and cats. In: Small Animal Practice. 55 (2010), pp. 255-261.
- ↑ undescended testicles. University Department for Pediatric and Adolescent Surgery in Donauspital / SMZ Ost Wien
- ↑ Axel Wehrend: Key symptoms of gynecology and obstetrics in dogs. Enke, Stuttgart 2010, ISBN 978-3-8304-1076-8 , p. 57.
- ^ A b Axel Wehrend: Chronic diseases of the male genital apparatus and their management. In: 55th Annual Congress of the German Society for Small Animal Medicine. 2009, proceedings, part 3, pp. 1–3.
- ↑ C. Schwentner: The neoadjuvant GnRH treatment improves the fertility index of non-descended testes. In: Journal of Urology and Urogynaecology. 2004; 11 (special issue 7)] (PDF; 1.4 MB)
- ↑ Götz Borgwardt: Bernhard Schapiro (1888–1966): Talmudic scholar - doctor - pioneer of the hormone treatment of cryptorchidism. In: Würzburger medical history reports 23, 2004, pp. 393–411; here: p. 403 f.
- ↑ What is undescended testicles in boys? In: BabySOS . ( baby-sos.de [accessed on November 6, 2018]).
- ↑ S2k- guideline undescended testes - undescended testis of the German Society for Pediatric Surgery (DGKCH). In: AWMF online (as of 2013)
- ↑ Inner Boar . know.de. Retrieved April 13, 2019.
- ↑ Inland stallion . woerterbuchnetz.de. Retrieved April 13, 2019.
