Why there may be no testicle
The testicles are laid in the abdominal cavity and usually descend into the scrotum by the time of birth. If the formation process is disrupted at an early stage, the organ does not develop at all. Another mechanism is much more common: the testicle formed normally, but in the prenatal period, torsion of its vessels occurred, the blood supply stopped, and the organ died. In such cases, only a small remnant of tissue is found during surgery. True bilateral anorchism is very rare and is accompanied by a lack of intrinsic testosterone.
- Violation of organ laying in early pregnancy
- Intrauterine torsion of testicular vessels
- Vanishing testicle syndrome
- Chromosomal and hormonal developmental disorders
- Sometimes - a consequence of surgery or trauma in childhood
How is it different from cryptorchidism?
This is the most important question on which tactics depend. In cryptorchidism, the testicle exists, but is delayed on its way to the scrotum. It needs to be detected and removed surgically, preferably in the first or second year of life: this reduces the risk of infertility and malignant tumor. With anorchism there is nothing to omit, but the absence of an organ can only be confirmed after a thorough search, including diagnostic laparoscopy. Therefore, the diagnosis of “no testicle” is not made based on ultrasound alone.
- Cryptorchidism - there is a testicle, but not in the scrotum
- Testicular retraction in children is a normal variant; the testicle descends when it relaxes
- Anorchism is confirmed by hormonal tests and examination of the abdominal cavity
- Undescended testicle requires surgery
- A testicle left in the abdominal cavity increases the risk of tumors
How does it affect hormones and fertility?
One healthy testicle can produce enough testosterone and sperm, so most men with monorchidism develop normally and can have children. However, their sperm quality is, on average, somewhat lower, and when planning a pregnancy, it is wise to have a spermogram done. With anorchism, one's own testosterone is not produced: without treatment, puberty does not occur, and osteoporosis and other consequences of hormone deficiency develop in adulthood. Natural conception in this case is impossible.
- Monorchidism - usually normal hormones
- Possible moderate decrease in sperm count
- Anorchism - lack of own testosterone
- Puberty does not occur without therapy
- Replacement therapy ensures normal development and quality of life
Survey
They begin with an examination: the doctor carefully palpates the scrotum and inguinal canal in a warm room to prevent retraction of the testicle. Then an ultrasound scan of the scrotum and groin areas is performed. A hormonal study helps to understand whether the body has working testicular tissue: in its absence, the levels of FSH and LH are elevated, and testosterone is low. In doubtful cases, stimulation tests are used in children. The final answer for a non-palpable testicle is given by diagnostic laparoscopy, which, when an organ is detected, immediately goes into treatment.
- Examination by a pediatric urologist or andrologist
- Ultrasound of the scrotum and inguinal canals
- Testosterone, FSH, LH
- Stimulation tests as prescribed by an endocrinologist
- Karyotyping for combined anomalies
- Diagnostic laparoscopy for a non-palpable testicle
What do they do next?
With monorchidism, no special treatment is required, but the only testicle must be protected: protection during contact sports and immediate consultation with a doctor in case of any acute pain in the scrotum are important, since torsion in this situation is especially dangerous. For anorchism, the endocrinologist selects testosterone replacement therapy, starting it in adolescence, to ensure normal sexual development. At the request of the patient, it is possible to install a silicone testicular prosthesis - this is a cosmetic operation and does not affect hormones.
- Regular observation by a urologist
- Protecting the single testicle during sports
- Immediate treatment for acute scrotal pain
- Testosterone replacement therapy for anorchism
- Spermogram when planning pregnancy
- Testicular replacement if desired
- Psychological support for a teenager if necessary
