Hypoplasia of the testicles

Hypoplasia testes - congenital hypoplasia of one or both testicles, leading to androgen deficiency. Hypoplasia of the testes and is accompanied by a decrease in the size of the asymmetry of the scrotum, the small size of the penis, a violation of puberty, pseudogynecomastia, decreased libido, impotence viagra effects, male infertility. The diagnosis of testicular hypoplasia is based on inspection and palpation of the scrotum, the results of ultrasound of the scrotum, sperm, study the level of total and free testosterone. Treatment of testicular hypoplasia include hormone replacement therapy, prosthetics underdeveloped testicle transplant donor organ.

Hypoplasia testes - malformation of the male sex glands, associated with the small size and lack of function of one or both testicles. Malformations of the testicles occur in 5-7% of newborn boys. Among the inborn errors of isolated anomaly amount (anorchia, monorchism, poliorhizm), position (cryptorchidism, ectopic) and structure (hypoplasia and aplasia) testicles. Hypoplasia of the testes may occur in varying degrees, from a slight decrease in the size of the gonads to their complete absence. Hypoplasia of the testes may be unilateral (hypoplasia of the left or of the right testicle, the second is developed normally) and bilateral (dimensions of the left and the right testicle is significantly smaller than normal).

Testicles (testes, testicles) are paired male sex glands and perform the dual function of reproduction (development and maturation of male germ cells - sperm cells) and endocrine (incretion primary male sex hormone - testosterone). That testicles determine the development of primary and secondary sexual characteristics and the implementation of the reproductive capacity of the man. Testicles have a firm texture, oval, slightly flattened shape. Their dimensions normally are as follows: 4.5 cm long, 3.2 cm wide; weight 20-30, the testicles are located in the scrotum, and are separated by a partition. This localization of the testes associated with the achievement of optimum temperature (32 ° C), required for spermatogenesis. Each egg is covered with several shells and consists of lobules filled with a network of direct and convoluted seminiferous tubules. To the rear surface of each testis closely adjoins the epididymis, vas deferens where begins.

Testicular hypoplasia develops as a result of violation of their formation in the early stages of fetal life. The earlier the damage occurs, the more pronounced degree of abnormality. Normally the sex glands begin to form from two embryonic structures: Wolffian and Müllerian ducts in the indifferent stage of embryogenesis. Further gonadal differentiation occurs in accordance with the genetic sex of the fetus. Formation of the testes is regulated gene SRY on the short arm of the Y-chromosome that encodes a particular protein - factor of testicular development. Testicles embryo very early become an active endocrine organ: the action of testosterone synthesized from volfovyh ducts formed epididymis, vas deferens and seminal vesicle, and under the influence of antimyullerovogo factor inhibited the development of Müllerian ducts in a male fetus. Bookmark testes in the embryo occurs in the abdomen, but the time of birth they descend through the inguinal canal into the scrotum. The development of the testes is actively going on at puberty and ends in 17-18 years.

The main reason for testicular hypoplasia are chromosomal and genetic abnormalities (violation of the structure or the sex chromosomes, gene damage responsible for the differentiation of the sex of the fetus). For example, testicular hypoplasia Klinefelter's syndrome is associated with the presence of extra X chromosome karyotype (47HHU, 48XXXY); with Turner's syndrome - a translocation of the X-chromosome in the Y-chromosome or mosaicism X-chromosome. The syndrome rudimentary testes formation of internal genital organs occurs simultaneously from the Müllerian and Wolffian ducts and leads to the formation of a child's immature female and male genital organs.

Predispose to testicular hypoplasia may pathology of pregnancy, hormonal imbalance (estrogen intake of pregnant and progestin drugs, the presence of hormonally active tumors), teratogenic effects of various factors on prenatal development of the gonads, damage to the central nervous system of the child during a difficult birth. Hypoplasia of the testes may be accompanied by hypoplasia of other endocrine organs such as the thyroid gland. Often the cause of hypoplasia of the testes may be trophic changes or autoimmune defeat testicular tissue, leading to disruption of the development of the gonads. The risk of hypoplasia of the testes in boys increases if the disease runs in families.

Hypoplasia of the testicles is often asymptomatic and is detected by accident when handling the patient to a urologist about infertile marriages. In hypoplastic testes scrotum looks less than normal due to reduction of the size of one or both glands ranging from 0.5-0.7 to 2.5 cm. It is also characterized by hypoplasia of the epididymis and prostate.

The main symptom of testicular hypoplasia is a violation of hormonal background; while disease severity is determined by the degree of reduction of testosterone. In unilateral hypoplasia of the testes due to compensatory mechanisms, the second healthy iron takes over part of the functions, so the hormone levels change slightly. At the same time a healthy testicle is significantly increased in size. With a small degree of hypoplasia of the testes spermatogenesis proceeds normally, and man is able to conceive a child on their own.

With bilateral lesions of the main manifestations of testicular hypoplasia is severe androgen deficiency, violation of puberty syndrome, decreased libido, impotence, impaired spermatogenesis (oligoastenoteratozoospermiya, astenoteratozoospermiya, theratozoospermia). Delayed puberty with hypoplasia of the testes is characterized by underdevelopment of secondary sexual characteristics in boys older than 14 years: lack of pubic and axillary hair distribution, lack of coarsening of voice, nocturnal pollutions, infantilism of the external genitalia (small penis <5 cm, testicular volume <4 ml, no folding and sagging scrotum). Build these patients disproportionate, closer to the female type; characterized pseudogynecomastia.

Hypoplasia of the testes occurs in alcoholic embriofetopatii, hypogonadism, adrenal tumors (corticosteroma), different syndromes (Klinefelter, Alstroma-Olsen, Turner, Bard-Biedl et al.), Pituitary dwarfism, epispadias. Hypoplasia of the testes can lead to serious consequences: male infertility, testicular atrophy and degeneration and the development of prostatitis, malignant tumors (testicular cancer).

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