All about glands and hormonal system
Monorchism is a pathology of the genital organs, in which one testicle is absent, its appendage and the deferent duct. The reasons for the development of monorchism in children are still not exactly known. According to scientists, intrauterine pathologies arise under the influence of toxic substances and viruses, hormonal disruptions in the mother's body during pregnancy, genetic disorders, etc.
Usually congenital monorchism is found already at the first examination of a newborn child. However, an accurate diagnosis can only be made on the basis of the results of a comprehensive examination: pelvic and abdominal ultrasound scans, scrotal vascular scans, hormone level assessments, etc.
Comprehensive diagnostics of monorchism allows to exclude:
- cryptorchidism - a pathology in which one of the testicles did not descend into the scrotum, but remained in the peritoneum or inguinal canal,
- testicular hypoplasia - the organs are located in the scrotum, but they are small, therefore they are not detectable on palpation,
- aplasia of the kidney - many children with monorchism are also diagnosed with congenital hypoplasia or lack of a kidney.
During the diagnosis, doctors evaluate the condition of the second testicle. If its size does not correspond to the age norm, it is necessary to exclude hypogonadism and other congenital endocrine pathologies, which in the future may adversely affect fertility and sexual function.
Treatment of monorchism in children
Children diagnosed with congenital monorchism should be regularly examined by an andrologist. Medical monitoring is especially important during puberty. Due to the lack of a single testicle, the development of the reproductive system may slow down. To prevent complications, the doctor may prescribe hormone replacement therapy in puberty.
Prolonged comprehensive treatment is necessary for children who have been diagnosed with monorchism and primary hypogonadism. Hormone therapy will protect against developmental delays and preserve sexual function in adulthood.
Implications of monorchism
In the absence of hormonal disruptions and endocrine disorders, monorchism in children usually does not affect the potency and fertility in the future, does not require treatment. An adult man with such a diagnosis will be able to have a sex life and become a father. A healthy testicle assumes all the functions absent, due to which it may slightly increase in size.
Asymmetry of the scrotum with monorchism often causes psychological discomfort in men, provokes the development of complexes, and has a negative effect on the libido. To eliminate the aesthetic defect and increase self-confidence will help testicular testicles. For each patient, the size of the implant is chosen individually to get the most natural result.
The approximate price for prosthetic testicles, see the price list on the website. To find out the exact cost of the operation, sign up for a consultation with a doctor.
The diagnosis of monorchism is most often made even in the hospital, since its manifestations are quite obvious. A newborn boy is missing one testicle. This can manifest itself in this way:
- an incompletely formed organ remains in the abdominal cavity or inguinal canal, i.e. it does not descend into the scrotum,
- the testicle does not fully develop, but is located in the scrotum,
- the formed organ undergoes degenerative processes and moves from the scrotum back into the abdominal cavity.
Monorchism in children is formed at the initial stage of intrauterine development. At the same time, hypoplasia of the epididymis or their presence in the immature scrotum may be observed.
One of the reasons is a violation of the process of moving the testicles to the scrotum.
The following factors are capable of provoking such violations:
- pregnancy pathology,
- taking a woman some medications
- hormonal disruptions
- infectious diseases in pregnant women,
- genetic factors.
Manifestations of pathology
The most active monorchism in the boy begins to manifest itself during puberty. Initially, you can only visually notice the asymmetry of the scrotum and the underdevelopment of one organ. Further symptoms begin to appear:
- slow body hair
- slowing the development of the penis,
- late wet dreams
- propensity to gain weight,
Important: you can see that a normal testicle increases in size relative to the norm. This is due to the fact that it takes on a double load.
A sign of possible violations is gynecomastia.
Thus, the main symptoms of the disease are disorders of the manifestation of secondary sexual characteristics. This process is most intense when a teenager is 14 years old. Further testosterone deficiency may be found if a normal testicle fails to cope with its production or also has certain disorders.
Consequences and associated pathologies
The specific consequences of monarchism depend on the degree of development of other organs and the measures taken by the man to compensate for the deficiency. The main problems can be:
- Erectile Dysfunction
- decreased libido
- testosterone deficiency
- excess of female hormones with concomitant manifestations,
- psychological discomfort.
Disruption of hormonal levels may trigger male obesity.
And the main question that accompanies monorhism: is it possible to have children? Here it is necessary to consider two situations. First: if a man has a second testicle that functions normally and he maintains his health by taking medications prescribed by a doctor, it is possible to have healthy offspring. Second: there are violations in the work of the second testicle, there are problems with the sexual plan against the background of testosterone deficiency. Then, in most cases, male infertility is diagnosed and it can hardly be treated.
Important: quite often monorchism is accompanied by the absence of one kidney. This is due to the fact that these organs are formed from a tissue of the same type.
It is impossible to cure monorchism in a man; one can only eliminate some of its consequences. For example, hormone replacement therapy is used to compensate for imbalance and restore male sexual health. This is especially important during puberty, when the organs of the boy's reproductive system are finally formed and secondary signs appear. Luteotropic, follylostimulating hormones and testosterone are prescribed.
Important: it is obligatory to consult a psychologist to overcome moral barriers and discomfort regarding physiological imperfections.
It is possible to eliminate the visual manifestations of pathology through surgical intervention. To begin with, the unformed organs are removed from the scrotum: the testicle and its appendage. Next, a silicone implant is inserted inside. Its size should be as close to a healthy testicle.
Artificial testicle implants
It is important to prevent injuries to the groin area so as not to jeopardize reproductive functions. It is difficult to completely prevent monorchism when it comes to the genetic component of the problem. However, a healthy pregnancy, the absence of bad habits in the mother can significantly reduce the risks involved.
What the doctor does
It is necessary to treat the disease in view of concomitant disorders, in particular endocrine disorders. With a deficiency of testosterone and other hormones, first aid is the appointment of hormone replacement therapy. It is completely impossible to eliminate the pathology, but in order to conceal the cosmetic defect and rid the child of psychological experiences during puberty, doctors can prescribe an operation to implant the silicone implant in place of the missing testicle.
When the examination shows damage to the saved testicle, effective treatment is necessary in order to restore its full functioning. As a rule, hormone replacement therapy is prescribed only after the child reaches puberty. Otherwise, it can cause impaired development of the external and secondary genital organs, which would entail a serious psychological trauma.
Similarly, the implant installation operation is performed only after 14 years to eliminate the difference from peers. The procedure is quite simple and does not threaten the health of the child. In order for the results to be as aesthetic as possible, the doctor carefully selects the size of the implant, in accordance with the size of a healthy testicle. The operation is also carried out when it is necessary to urgently remove an underdeveloped testicle.
Preventing intrauterine monorchism helps to abandon bad habits, compliance with the recommendations of doctors when taking drugs during pregnancy, avoiding infectious diseases. Acquired monorchism can be prevented if you follow the movement of the child, avoiding injury to the area of the external genital organs.
Disease manifestation factors
Monorchism occurs as a result of fetal developmental abnormalities. At some stage of fetal development, the external genitals may be formed incorrectly in the embryo. This leads to the fact that only one testicle develops. The second can not develop at all or as a result of an underdevelopment it remains in an abdominal cavity or in the inguinal canal.
As a result of agenesis, the testicle does not develop at all. But during the degeneration, the testicle was already formed, but, as the diagnosis shows, it went back to the abdominal cavity. These symptoms are detected at birth. A neonatologist makes a diagnosis by examining and probing the scrotum of a newborn.
Why is one testicle missing?
Monorchism often occurs with symptoms such as lack of a kidney. The reason for this symptom is that the kidney and testicle develop from the same tissue. So a child can simultaneously develop and monorhism, and the absence of a kidney.
In addition, monorchism implies signs of the absence of an epididymis. In some cases, in the scrotum may be underdeveloped appendage. However, often the half of the scrotum, where the testicle was supposed to be, is also underdeveloped.
That egg, which is present in the body, after puberty exceeds normal size. This is due to the fact that it must compensate for its activities in conditions of insufficient functionality. But often monorchism is combined with the symptoms of so-called hypogonadism. In such cases, boys develop underdevelopment of secondary sexual characteristics.
Blood tests indicate low blood testosterone levels. This has consequences such as reduced libido, erectile dysfunction, and in some cases, a complete inability to conceive a child.
Impact on puberty boy
The absence of one testicle can lead to delayed sexual development in boys and, in some cases, obesity.
In the pre-pubertal period, the development of the boy is no different from the norm. However, upon reaching the time of puberty, symptoms of the absence of the testicles begin to appear. Among them are the following:
- slowing the growth of the penis after reaching the age of fourteen,
- slowing down hair growth
- wet dreams occur much later or not at all, if there are signs of impaired functioning of a healthy organ,
- There is a tendency to obesity.
How is the disease diagnosed
Exact diagnosis of monorchism is possible only according to the results of laboratory and clinical diagnostics. An informative method of diagnosis is the inspection, as well as palpation of the external genital organs. In this case, the diagnosis is complemented by a thorough study of the history. The presence of burdened heredity further confirms the results of diagnosis.
Gonadotropins in the disease - increased, and testosterone - reduced. These symptoms and allow the diagnosis to assert that the boy has abnormalities in the structure of the genital organs. Diagnosis of monorchism allows determining adequate substitution treatment to preserve the reproductive health of a man.
Features of therapy
The treatment of such pathology as monorchism is reduced to supportive and conservative therapeutic measures based on diagnostics. This takes into account the stage of the disease. If the remaining testicle does not detect symptoms of impairment, then this does not lead to infertility and the man remains capable of conception. Another thing - if the only testicle according to the results of the diagnosis has symptoms of damage. In some such cases, conservative and substitution therapy may not be effective.
Conservative treatment usually consists of taking luteotropic hormone, as well as follylo-stimulating hormone. If there are symptoms of hypogonadism, then prescribed testosterone medication.
Replacement therapy with hormones is also important during puberty. This is due to the fact that the lack of sex hormones in this period will cause a disturbance in the development of the genitals, as well as the underdevelopment of secondary sexual characteristics. In turn, this may cause the development of psychological trauma in a teenager.
When surgery is required
Surgical treatment in the absence of one testicle does not eliminate the pathology, but restores the aesthetic appearance of the male genitalia.
Surgical treatment with silicone implants is recommended for all boys who are approximately 14 years old. This is done so that the psyche of the child does not suffer and he does not feel defective in comparison with his peers. This treatment is quite simple, since the operation is not dangerous.
When performing surgical treatment, it is important to select an implant of the same size as a healthy organ. This is due to the fact that the external treatment is important in the surgical treatment.
In addition, surgical treatment is necessary for such a reason, when it is necessary to remove the immature hypoplastic organ. Such an operation is best performed when the boy is about 14 years old. Possible complications due to surgery — scrotal edema, bleeding, and slow healing — are quite rare.
Monorchism in children begins due to impaired fetal development. At some point during fetal growth, the external genitals may not grow correctly in the fetus. This can provoke the formation of only one testicle. The latter either does not develop due to underdevelopment, or it remains in the inguinal canal or abdominal cavity.
After agenesis, the testicle no longer develops, and during degeneration it is formed, but already in the course of diagnosis one can find that it has gone again into the abdominal cavity. These signs appear already at the birth of a child.
As mentioned above, a child can have monorchism along with the absence of one kidney, since these two organs develop from the same tissue. The following symptoms of monorchism exist:
- the only fully developed testicle is usually characterized by a large size (it exceeds the average norm for the purpose of a peculiar compensation, which is called “vicar hyperplasia”),
- the work of this testicle may be impaired, and in some cases there is atrophy,
- sometimes there are signs that indicate hypogonadism (testosterone deficiency in the patient's body),
- lack of testosterone is manifested in reduced libido, impotence, infertility.
It is more correct to diagnose testicular monorchism before puberty begins. A simple diagnosis is carried out by palpation. However, palpation is often not enough, and therefore there is a chance to confuse monorchism and cryptorchidism (a phenomenon in which the testicles do not descend into the scrotum). In this case, it is worth resorting to modern diagnostic methods.
- ultrasound procedure. During this procedure, dopplerography of the scrotum is performed. This method makes it possible to find the testicle and in this way distinguish monorchism from cryptorchism,
- laparoscopy. It is used when there is a suspicion that the testicle is located in the abdominal cavity,
- angiography of the scrotum vessels. The location of the vessels, its indication of the presence or absence of the testicle in the scrotum, is investigated.
Treatment and preventive measures
When you need to begin to treat monorchism in children, first of all you should pay attention to conservative methods, due to the diagnosis. Stage development of the disease is also important to consider. If no disturbance is observed in the second remaining testicle, then the man may remain able to conceive. In the second case, signs of testicular damage may be present. Sometimes in similar situations, conservative treatment methods may be ineffective.
As a rule, conservative treatment involves the administration of special hormonal medications. При симптомах гипогонадизма врач назначает прием препаратов тестостерона.
At puberty, hormone replacement therapy plays an important role. This is explained by the fact that the lack of sex hormones in this period can cause abnormal growth of the genitals, and underdevelopment of secondary sexual characteristics. In the future, this may be the cause of the psychological trauma of the young man.
Since a sexual ailment is congenital, many factors predisposing to it are hidden during the prenatal formation. It is for this reason that the expectant mother should worry about the future baby. First of all, it is worth removing alcoholic drinks and smoking. This is worth taking care before conceiving a baby. In the first weeks of carrying a child begins the formation of the genitals of the baby.
Pregnant women should also not take potent drugs that can provoke pathology in the fetus. Any medication should be discussed with your doctor.
Men diagnosed with monorchism should try to protect a healthy testicle from injury: it will help to preserve health and be able to conceive a child.
Clinical manifestations of the disease
As a rule, monorchism can be detected immediately after the birth of the child in the maternity hospital, while bathing or other hygienic measures. Visually, the part of the scrotum, where there is no sex gland, is tucked up and hypoplastic - reduced in size. Therefore, the scrotum looks asymmetric. Also, during palpation of the genital and inguinal region, the testicle and its appendage cannot be found.
If there is no pronounced hypoplasia of the existing gland, the development of the child, until he reaches puberty, does not suffer. Thus, the main symptoms of monorchism are presented:
- complete absence of the left or right testicle, as well as its appendage,
- unilateral reduction of the scrotum,
- vicar hypertrophy of the second testicle - a compensatory increase in size (due to the fact that the remaining iron "takes" a double job).
Despite the fact that the development of the second testicle does not suffer at all, over time its reserves become insufficient to fully compensate for the functional state of the reproductive system. This leads to the development of latent or overt hypogonadism (deficiency of sex hormones, which has its clinical manifestations and consequences).
Manifestations of hypogonadism:
- disturbed formation and development of secondary sexual characteristics,
- erectile disfunction,
- decreased libido
If monorchism is combined with cryptorchidism or atrophy of the second testicle, then testosterone deficiency begins to manifest itself in puberty:
- slowing of hair growth in the armpits, pubis, etc.,
- late appearance of emissions,
- propensity for overweight,
- decrease in penis growth in adolescence.
Possible consequences of monorchism
The consequences of the disease depend on the degree and nature of the functional failure, the existing male reproductive gland. In most cases, the working condition of the patient’s reproductive system remains compensated, without causing any complaints or clinical manifestations.
When there is a shortage of testosterone production and there is no adequate replacement therapy (which subsequently leads to hypogonadism), symptoms of erectile dysfunction and infertility appear over time.
If there is only “pure” monorchism (a healthy second testicle, there are no laboratory and clinical manifestations of hypogonadism), treatment consists of implanting an artificial silicone prosthesis into the scrotum cavity. Most often, the operation is performed at the age of 12-14 years.
If latent insufficiency of the steroidogenic function of the testicles is recorded, or there are complaints and laboratory data characteristic of hypogonadism, then such patients are prescribed hormone replacement therapy with testosterone to prevent infertility.