[Early diagnosis and correct treatment of cryptorchism].

F Mantovani, A Cazzaniga, G Mastromarino, F Colombo, E Austoni
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Abstract

Diagnosis in cryptorchidism should be as early as possible for therapeutical purposes and for the achievement of most positive results. Early but also exact diagnosis allows a selective therapy concerning type of procedure and age of performance. Aims of early diagnosis and selected treatment are: prevention of infertility and eventual decrease of androgenic endocrinal function in the adult; prevention of torsion in retractile testis; prevention of trauma in perineal ectopic situation; prevention of cancer especially in cryptorchidism of the adult; prevention of psychogenic defects of the empty scrotum. Those goals can be obtained by different approaches: pharmacological (hormonal stimulation), surgical (orchidopexy) or by their association. If hormonal administration is not suitable or without results surgical approach will be adopted. Which is now the most suitable age for surgery? Testicular damages begin at the second year of life. Therefore operation should be acted in advance. However, up to date international acknowledgement is in favour of surgical management around the fourth year for the advantages of a more mature anatomical situation without reducing quality of results. Purpose of early diagnosis and selective therapy in cryptorchidism is to avoid irreversibility of severe histological alteration able to compromise gonadal, especially germinal, function. It is never to forget that the high level of infertility in cryptorchidism can be depending not only on evident alteration in number, motility and morphology of spermatozoa but also on morphofunctional defects escaping from the routine seminal examination. All that is in tight connection with the intrinsic dysmorphism in cryptorchism where the abnormal position of the testis is only a partial aspect.(ABSTRACT TRUNCATED AT 250 WORDS)

隐睾的早期诊断和正确治疗。
为了治疗目的和获得最积极的结果,隐睾的诊断应尽早进行。早期但准确的诊断允许根据手术类型和表现年龄进行选择性治疗。早期诊断和选择性治疗的目的是:预防不孕症和最终降低成人雄激素内分泌功能;收缩性睾丸扭转的预防会阴异位创伤的预防预防癌症,特别是成人隐睾症;空阴囊心因性缺陷的预防。这些目标可以通过不同的方法实现:药理学(激素刺激),外科(兰花切除术)或通过它们的结合。如果激素治疗不合适或没有效果,将采用手术方法。现在哪个年龄最适合做手术?睾丸损伤开始于生命的第二年。因此,操作应提前采取行动。然而,最新的国际认可是在第四年左右赞成手术治疗,因为在不降低结果质量的情况下,解剖情况更成熟。隐睾的早期诊断和选择性治疗的目的是为了避免严重的组织学改变的不可逆性,从而损害性腺功能,特别是生殖功能。永远不要忘记,隐睾患者的高水平不育不仅取决于精子数量、活力和形态的明显改变,而且还取决于常规精液检查中逃脱的形态功能缺陷。所有这些都与隐睾的内在畸形密切相关,在隐睾中,睾丸的异常位置只是部分方面。(摘要删节250字)
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