The dangers of cryptorchidism, its standardized diagnosis and treatment, and the classification and prevention of various types of orchitis.

Why do the testes fail to descend into the scrotum as normal? The main process is regulated by the body's endocrine system. Human chorionic gonadotropin (hCG) secreted by the placenta stimulates the embryonic testes to produce testosterone, which is then converted to dihydrotestosterone (DHT) by enzymes, thus promoting testicular descent. Therefore, if the mother abuses estrogen or progesterone during pregnancy, the fetal testes will not secrete enough androgens. Various reproductive endocrine factors can cause an imbalance in the secretion of these hormones, affecting the testicular descent process. However, the main cause of cryptorchidism is related to local mechanical factors. For example, a short spermatic cord connecting the testes, narrowing or premature closure of the inguinal canal, absence of the gubernaculum testis (the ligament connecting the testis to the base of the scrotum), adhesions between the testes and surrounding tissues, scrotal hypoplasia, or the testes entering a "side path" instead of following the gubernaculum testis can all cause cryptorchidism. Some scholars believe that the condition of the testes themselves, such as insufficient development, also contributes to cryptorchidism. Therefore, the idea that one testicle has descended and everything is fine is extremely dangerous. Besides the threat of cancer in the undescended testicle, the descended testicle may also be underdeveloped, so early examination and treatment are essential.

Cryptorchidism has many harmful effects. It keeps the testicles at a relatively high temperature, preventing normal sperm production. Bilateral cryptorchidism can cause infertility due to azoospermia, with an incidence rate of 50%–100%. Unilateral cryptorchidism can affect the contralateral testicle, with an infertility rate of 30%–60%. If the testicle remains in the groin or pubic region, it is easily damaged due to pressure because of the lack of scrotal protection. The chance of developing tumors in cryptorchidism is 20–50 times higher than in normal individuals. Approximately 8% of patients with cryptorchidism will develop cancer. The peak age of onset is usually 25–35 years. Some have pointed out that repositioning the testicle after age 10 does not help restore fertility or reduce the possibility of malignancy. The psychological impact of not having a testicle in the scrotum, the inferiority complex caused by poor development of secondary sexual characteristics, and infertility after marriage can all cause severe psychological trauma to patients. Therefore, it is inappropriate to think that unilateral cryptorchidism is harmless and not seek timely treatment. Of course, bilateral cryptorchidism should be diagnosed and treated promptly in childhood.

Cryptorchidism, also known as undescended testis, refers to the inability to palpate the testicles in one or both sides of a boy's scrotum. Whether the testicle remains in the abdominal cavity, in the groin, or above the scrotum, it is considered undescended testis, and all these conditions require treatment for testicular malformation. During the embryonic period, the two testicles are located on either side of the waist in the abdominal cavity. As the fetus develops, the testicles gradually descend. Statistics show that approximately 3% of newborns have testicles that do not descend into the scrotum, but most descend within 6 weeks of birth. Bilateral cryptorchidism, if left untreated, can have serious consequences. The temperature inside a normal scrotum is 2-3°C lower than body temperature, which is ideal for testicular development. If both testicles are constantly in the relatively warmer abdominal cavity or groin, it hinders healthy testicular development, causing atrophy of the testicular germinal epithelium and leading to infertility. Furthermore, such testicles produce very little androgen, which can impair male puberty sexual development, leading to low libido and affecting fertility. Unilateral cryptorchidism does not affect puberty sexual development or fertility. However, unilateral testicular hypoplasia can affect the contralateral testis, potentially reducing sperm count or impairing sperm cell function, thus indirectly impacting fertility. Bilateral cryptorchidism results in infertility. Most seriously, there is a high risk of testicular cancer developing in the abdominal cavity, and once cancer develops, its malignancy is extremely high. Furthermore, the inguinal testis is easily injured during childhood activities, causing severe pain and potentially affecting development.

If parents find that they cannot feel the testicles in their child's scrotum, they should promptly take the child to the hospital for an ultrasound or CT scan to determine the exact location of the testicles; testosterone levels can also be tested to assess testicular development. Treatment for cryptorchidism mainly involves two methods: surgical treatment and drug treatment. ① Surgical treatment. Surgery should be performed between 1 and 2 years of age. Generally, reproductive cell development begins to be affected at 10 months, and the impact becomes significant after age 2. If surgery is not performed before age 2 for various reasons, it should not be later than age 6. Statistics show that if cryptorchidism is treated after age 7 (called orchiopexy), there are still many cases of death due to cancer around age 30, a significant difference compared to surgery performed before age 6. Furthermore, when children start school and urinate with other children, cryptorchidism can cause significant psychological stress, and childhood trauma can have lifelong effects. Therefore, the earlier cryptorchidism surgery is performed, the better. ② Drug treatment. Treatment of cryptorchidism with gonadotropins commonly involves injecting human chorionic gonadotropin (hCG) around the age of one, or using luteinizing hormone-releasing hormone (LH-FRAG) nasal drops. While this may lower the level of cryptorchidism in milder (lower) cases, prolonged use can interfere with normal testicular and external genital development. Therefore, hormone therapy is generally only used for diagnostic testing, comparing testosterone levels before and after treatment to assess testicular development. If testosterone levels do not increase after hormone use, testicular repositioning surgery is unnecessary; instead, the affected testis should be removed. For future psychological support, implanting a prosthetic testis can be considered.

Orchitis is mainly divided into two categories, and their different characteristics and prevention and treatment are as follows: (1) Acute nonspecific orchitis: It often occurs in patients with urethritis, cystitis, prostatitis, prostatectomy, and long-term indwelling catheters. Common pathogens include Escherichia coli, Proteus, Staphylococcus, and Enterococcus. The routes of infection include hematogenous, lymphatic, or ascending infection. In most patients, the inflammation spreads from the epididymis to the testis. From the naked eye, nonspecific orchitis is characterized by varying degrees of testicular enlargement, congestion, and tension. When the testis is dissected, small abscesses can be seen. Histological observation shows numerous focal necrosis, connective tissue edema, and infiltration of segmented neutrophils. The seminiferous tubules show inflammation, hemorrhage, and necrosis. In severe cases, testicular abscess and testicular infarction may form. ① Clinical manifestations. It is mostly unilateral, often accompanied by chills and fever, testicular pain radiating to the groin, nausea and vomiting, scrotal skin congestion and edema, testicular enlargement, and hydrocele. Diagnosis is primarily based on physical examination of the testis, including signs such as redness, swelling, heat, and pain. However, it needs to be differentiated from acute epididymitis, spermatic cord torsion, and incarcerated inguinal hernia. Treatment includes local cold or hot compresses, scrotal elevation, nerve block therapy, and antibiotics. If an abscess has formed, incision and drainage are necessary. Orchiectomy is recommended when the testis is completely destroyed. For orchitis caused by long-term indwelling urethral catheters, the catheters should be removed as soon as possible.

(2) Acute mumps orchitis: This is the most common cause of orchitis caused by the mumps virus entering the testis via the bloodstream. It is more common in men in late puberty. The testis is visibly enlarged and bluish. When the testis is cut open, the testicular tubules cannot be expelled due to interstitial reaction and edema. Histological observation shows edema and vasodilation, with a large number of segmented neutrophils, lymphocytes and macrophages infiltrating, and varying degrees of degeneration of the seminiferous tubules. As the orchitis heals, the testis becomes smaller and softer. The seminiferous tubules are severely atrophied, but the interstitial cells of the testis are preserved. During the inflammatory process, the epididymis can be involved at the same time, with up to 85% of cases developing epididymitis. ① Clinical manifestations: The onset is rapid, generally appearing 3 to 4 days after the onset of mumps. The scrotum has erythema and edema, and the body temperature can reach 40°C, with significant signs of collapse. In orchitis caused by mumps, about 30% of patients experience irreversible damage to sperm, and the affected testis is severely atrophied. Bilateral orchitis can lead to male infertility, but androgen secretion function is generally normal. ② Treatment. Antibiotics are ineffective for orchitis caused by mumps. To relieve testicular swelling and pain promptly, a low spermatic cord block injection of 20 ml of 1% lidocaine can be administered, which improves testicular blood flow and protects spermatogenesis. Literature reports that diethylstilbestrol and gamma globulin can reduce fever and alleviate testicular swelling and pain. Prednisone has similar effects. Using convalescent serum from mumps patients to reduce the incidence of orchitis is worth trying. ③ Prevention. Live attenuated mumps virus vaccine is an effective preventative measure against mumps, generally administered to susceptible children under one year old. Mumps hyperimmune globulin (20 ml) can also be injected during the incubation period to reduce disease progression. Routine use of estrogen or glucocorticoids also helps prevent orchitis in children with mumps.