Key points for the diagnosis and treatment of cryptorchidism and hydrocele in children
**Cryptosis**
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**2.1//What is cryptorchidism?**
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Cryptorchidism occurs when a patient's testicle fails to descend into the scrotum at birth due to various reasons. Cryptorchidism is often located in the abdominal cavity, groin, or other areas, and the patient's scrotum is empty.
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Cryptorchidism can be classified as unilateral or bilateral.
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In children with cryptorchidism, the testicles may descend into the scrotum on their own within the first year after birth. If they do not descend into the scrotum within two years, the possibility of them descending into the scrotum is very small. In other words, if the testicles of a child with cryptorchidism do not descend into the scrotum within two years after birth, treatment is necessary.
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**2.2//Why is cryptorchidism treated?**
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In patients with cryptorchidism, the development of the testicles is severely affected because they are not located in the scrotum, often leading to infertility in adulthood.
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Normal testes are located in the scrotum, where the temperature is 34-35 degrees Celsius, which is suitable for testicular development and sperm production.
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Because the scrotum has the function of contraction and relaxation, it relaxes when it is hot and contracts when it is cold, thus keeping the temperature of the testicles constant between 34 and 35 degrees Celsius, which is conducive to testicular development and sperm production. In patients with cryptorchidism, the testicles are not in the scrotum, and their temperature is consistent with the body temperature between 36 and 37 degrees Celsius, so their development and spermatogenesis are seriously impaired.
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Undescended testes are prone to malignant transformation. The rate of malignant transformation in undescended testes is 40 times higher than that in testes with normal positions. It is one of the causes of testicular tumors.
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**2.3//How to treat cryptorchidism?**
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Surgery is the most effective treatment for cryptorchidism.
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The surgical procedure involves releasing the spermatic cord and fixing the testicle.
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When is the best time to have surgery?
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Research has shown that if the testicles are still not in the scrotum by age 2, pathological changes have already occurred. In other words, if cryptorchidism is not treated by age 2, the testicles have already been damaged. Therefore, the best time for cryptorchidism surgery is before age 2 and after age 1.
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> After surgery during this period, the child's testicles are hardly affected.
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**Pediatric hydrocele**
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> 3.1 // What is hydrocele in children?
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Hydrocele is actually caused by fluid flowing from the abdominal cavity into the scrotum through a cavity that connects the scrotum containing the testicle. Anatomically, the cavity in the scrotum containing the testicle is called the tunica vaginalis, which originates from the peritoneal cavity. However, the passage between the abdominal cavity and the tunica vaginalis closes after birth. If it does not close after birth, it is called communicating hydrocele in children.
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Hydrocele in newborns usually resolves on its own within the first year of life.
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In adults, hydrocele is mostly caused by excessive fluid production within the tunica vaginalis of the testis, with inflammation being a common cause.
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Hydrocele is often classified into testicular hydrocele, spermatic cord hydrocele, and communicating hydrocele. Their pathological processes are largely the same, with communicating hydrocele being the most common in children.
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> 3.2 // How to tell if a child has hydrocele?**
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The manifestation of hydrocele is that after or shortly after birth, one side of the scrotum is found to be sometimes larger than the other, or one side of the scrotum is significantly larger than the other. The enlarged scrotum is sometimes translucent in sunlight, as if it contains fluid. This is a manifestation of hydrocele.
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In folk tradition, hydrocele in children is called "qi oviduct," which is said to be related to the child's bad temper.
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**3.3//What are the dangers of hydrocele? How is it treated?**
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> ① It affects testicular development. After hydrocele, the pressure on the surface of the testis increases, the blood supply to the testis is poor, and the development is restricted.
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②If communicating hydrocele is not treated in time, it can induce a hernia, that is, the intestines and other organs in the abdominal cavity can protrude into the scrotum, causing discomfort to the testicles and affecting development.
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③ It affects the appearance and also has a psychological impact on the child.
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Prevention: There is no good way to prevent it.
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Treatment: Surgery, ideally performed between the ages of 2 and 6.