Журнал «Здоровье ребенка» 5 (65) 2015
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Modern problems in children andrology
Авторы: V.A. Dihtyar, L.M. Harytonyuk, M.V. Boyko, M.V. Savenko, A.V. Obertynskyy, O.A.Ostrovska, K.V. Shevchenko
SE "Dnipropetrovsk Medical Academy", CI «Dnipropetrovsk Regional Children’s Hospital»
Рубрики: Семейная медицина/Терапия, Педиатрия/Неонатология
Разделы: Клинические исследования
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Recently significantly increased the number of infertile men. According to domestic and foreign authors now this group is 40-60%. Among the most frequent causes of reproductive disorders and sexual disorders in adulthood is a varicocele, cryptorchidism and testicular acute diseases (TAD). The incidence of infertility for bilateral cryptorchidism occurs in 10% of patients at TAD - 40-44% of boys in varicocele - in 20-80% of adolescents.
The frequency of cryptorchidism is observed up to 2-4% full-term newborn and up to 30% - in preterm infants in adult males - 0.7-0.8%. Reproductive function for cryptorchidism is laid in childhood and is determined by numerous factors, including the severity of the primary lesion gonads, timely diagnosis and treatment. The normal development of the testes is determined by their localization in the scrotum. Histological proved that intraperitoneally in the testes defined morphological degenerative changes. Severe complications are malignant degeneration distopic testis (up to 35 times more likely to occur pulpy testis) and testicular torsion.. Foreign scientists point to the period of 6-12 months, surgery and pediatric urology CIS recommend surgery within 2-3 years. Treatment may be therapeutic (hormonal) or surgically. The efficacy and the role of hormone therapy remains debatable topic. Open surgery involves the mobilization of the testes and spermatic cord followed by fixing it to the shell scrotum. Most authors prefer testicular fixation by Petryvalskyy. In short testicular artery, when it impossible to do one-stage orchiopexy, used multistage orchiopexy or microsurgical testicular autotransplantation to form an anastomosis between the peritoneal and testicular arteries. Some hospitals use laparoscopy.
Entitled TAD children combine different pathological conditions can be due to factors as infectious and noninfectious. Particularly noteworthy are testicular torsion, torsion of hydatid of Morgagni and orchiepididymitis. The complexity of the differential diagnosis TAD associated with clinical similarity to other disease and the lack of knowledge of pediatricians, surgeons general of this pathology. A large proportion of testicular atrophy - up to 44% and an increase in the number of children with testicular torsion require review and selection of the most rational tactics of treatment of children with TAD.
For 3 years were operated 370 children with cryptorchidism, 490 children with acute testicular disease and 393 with varicocele. In analyzing the age characteristics of children with cryptorchidism was found that the largest group of children was operated at the age of 3 years - 242 boys (62%). But is sufficiently large group of children - 84 (38%) operated at the age of 6 years. Bilateral cryptorchidism detected in 34 boys; right sided - in the 193 and 131 - left-sided, testicular agenesis in 32 (8.6%) patients. Inguinal retention defined - in 338 boys and abdominal - in 20 patients. In 10% of patients were observed genetic disorders. Completed 390 surgeries, 350 (89%) Petryvalskyy’s orchiopexy, one-stage surgery (Stage fixation to the womb) - with 7 children and 1 Kettle-Torek’s surgery, 32 children held excision of vestiges of testicles ..
At the urology department treated 52 boys with testicular torsion, 490 with torsion of Morgagni’s hydatid and 50 of orchiepididymitis. Most age groups - are boys up to 3 years - 121 (22%) and from 7 to 15 years - 361 (60,7%), the most numerous group - children with torsion hydatid proof (91 and 313), and testicular torsion (9 and 26 boys). It is revealed later recourse. Increased the number children with acute testicular torsion, dominated the boys puberty. A significant number of patients were children with inflammatory testis and epididymis. Among infectious agents observed pathogens mumps (9.6%), urogenital infections (12.3%). Conducted 594 surgeries - skrototomy with operative exploration of shells testicle. Due to the testicular torsion performed 52 surgical interventions, often torsion of the left testicle (60%), including 8 orchiectomy and 44 detorsion, which amounted to 15.4% compared to the previous years - 46.5%. Children with varicocele performed 332 Bernard’s surgical interventions, 61 - Laparoscopic varicocelectomy.
Modern problems of the reproductive system in children and adolescents have the medical and social aspects. There is a need in active early identification of children with andrological diseases and restoration of health examinations of children in the organization of children's andrology service.
Among andrological problems cryptorchidism and TAD is the most common cause of disorders of the reproductive function and sexual disorders in adulthood. Term treatment of cryptorchidism is 12-24 months.
The use of laparoscopic method of treatment grounded in intra-abdominal and bilateral cryptorchidism forms.