ANALYSIS OF SURGICAL TREATMENT OF CRYPTORCHIDISM IN EARLY AGE CHILDREN

ANALYSIS OF SURGICAL TREATMENT OF CRYPTORCHIDISM IN EARLY AGE CHILDREN

Iurii Danilenko

Md, children surgeon, tutor of S.Tentishev memorial Asian Medical Institute Kant city, Kyrgyzstan, Surgery department,

Kyrgyzstan, Bishkek

Anara Abdraimova

Md, dermatologist, tutor of S.Tentishev memorial Asian Medical Institute Kant city, Kyrgyzstan, Department of Obstetrics, Gynecology and Children's Diseases,

Kyrgyzstan, Bishkek

ABSTRACT

There were 36 male children from 1 to 2 years old with undescended testicle in our research. All the patients were surgically treated by various methods. The nearly result was marked as good.

Keywords: cryptorchidism, age, children, hypoplasia of testicle.

Actuality. Cryptorchidism (undescended testicle) refers to a congenital urological pathology of childhood, which directly affects the quality of reproductive function in a given individual in later life. (40-60%){1,2,4}.

Cryptorchidism is a disease of a congenital nature, in which there is an unusual location of the testicles that have stopped or deviated on the way to descend into the scrotum. The frequency of occurrence varies according to various sources from 3-5% of the newborn boys, but then decreases to 1-2% due to spontaneous descent of the testicle into scrotum in the first 3 months of a child's life.{3,5,6}.

Despite the prevalence of various methods for diagnosing and examining children (for example, ultrasound) and the availability of any information on the Internet and the media, the frequency of seeking treatment of children with cryptorchidism at an older age remains high every year.

It is known that the treatment of patients with this pathology at an older age causes a high risk of male infertility in the reproductive period (up to 70% of all patients with bilateral cryptorchidism) {1,2,4}.

The studied literature data indicate that over the past period of 70-80 years, the timing of the operation of cryptorchidism has constantly changed and depended on the opinions of different authors: 12-14 years, 3-5 years, up to 4 years, 2 years.Today, two main views on the duration of treatment remain - early treatment in infancy {1,3,5}. and delayed surgery - at 4-6 years. {2,4}.

The goal of the work: Presentation of nearly results of surgical treatment of cryptorchidism in children operated in early age.

Materials and methods of the study. At the period of time from 2018 to 2021 years, 28 children with cryptorchidism aged from 6 months up to 2 years were under our observation in the City Children's Clinical Emergency Hospital of Bishkek, in the department of children urology. It was the first cases in the Kyrgyz Republic, the surgery of descending the testicles in this age group.

Before treatment, anamnesis was collected from patients, generally accepted methods of examination were carried out: complete blood tests, general urine analysis, ultrasound of the scrotum and inguinal canals, ultrasound of the abdominal organs , dopplerography of testicular vessels.

4 patients (11.1%) had anomalies in the urinary system - incomplete doubling of the kidney, urethrohydronephrosis, hypospadias. In 12 patients (33.3%), anomalies were found in the cardiovascular system - non-closure of the foramen ovale, atrial septal defect.

Of the 36 (100%) operated patients, unilateral cryptorchidism was observed in 34 cases (94.4%), of which right-sided - in 23 patients (63.8%), left-sided - in 11 patients (30.5%) .Bilateral cryptorchidism was in 2 patients (5.5%).

For each patient, the method of surgical treatment was selected individually. With a sufficient length of testicular vessels, spermatic cord and its elements, the Sokolov method was used with our modification - in 10 patients (27.7%). The essence of the modification is the formation of a platform at the bottom of the scrotum for better fixation of the testicle . For this purpose, before descending the testicle down through the scrotum invaginated into the wound, a dissection of the inner layers of the scrotum to the skin is performed, as a result of which, during healing, a scar is formed between the outer shell of the testicle and the inner surface of the scrotum, which ensures reliable fixation of the testicle. However, in most cases, preference was given to the Torek-Herzen method - 26 patients (72.3%), which provides even more reliable fixation of the testicle to the bottom of the scrotum. So, our purpose was to achieve two goals - to maintain adequate blood supply to the testicle and good fixation testicles at the bottom of the scrotum.

The early age of surgical treatment of patients was chosen to prevent the development of degeneration processes in the undescended testicle.

All operated patients were re-examined after 6 months. Most of these patients were residents of the city of Bishkek and the surrounding areas, thanks to which we were able to check the results of the operation in the dynamics of 6 months.

RESULTS AND DISCUSSION. A total of 36 patients with cryptorchidism in the age from 6 months up to 2 years were operated on over 4 years.

All patients underwent surgical treatment in a planned manner by various methods. The condition, size of the testicle, the presence of vas deferens and testicular vessels were checkedduring the surgery.

There were no cases of testicular hypoplasia in this group of patients operated on according to the clinic's setting from 6 months to 2 years.

In the future, observing this group of operated children in dynamics for 6 months, we evaluated the immediate results of treatment according to the following parameters. There were indicated 2 types of treatment results:

1. The result was considered excellent if the testicle, after being brought down, compare to the size of a healthy testicle, was located at the bottom of the scrotum, became elastic in consistency and mobile.

2. Unsatisfactory result - if after the operation there was a retraction of the testicle into the inguinal region.

As a result, almost all patients had an excellent or good immediate result of the treatment. Testicular hypoplasia was not found in patients of this group. There were no cases of testicular retraction into the inguinal canal.

Conclusions:

Treatment of cryptorchidism in children at an earlier age gives better results, because the incidence of hypoplasia increases with age. Already at the age of over 2 years, morphological changes in the tissues of undescended testicles are observed, which indicates the need for treatment at an early age (6 months 1 year).

The immediate result of treatment of patients operated on in the early period was good. In all cases, testicular hypoplasia was not detected.

References:

1. Ashkraft K.U. Pediatric surgery / K.A. Ashraft, T.M. Holder. St. Petersburg: Pit-Tal, 1997.-T.2-392s.
2. Vasiliev V.I. Surgical tactics in cryptorchidism / V.I. Vasilyev / / Andrology and genital surgery.
3. Erokhin A.P. Cryptorchidism-M., Medgiz, 1995-344p.
4. Lonshakov B.V. Cryptorchidism, methods of operative correction taking into account the level of testicular retention / B.V. Lonshakov, V.N. .Moscow, 2002.-p.485.
5. Isakov Yu. F. “Pediatric surgery” M. 1978