Male reproductive organ malformation

　　1. Cryptorchidism. Rare, probably due to incomplete differentiation of testes during the embryonic development period, resulting in atrophy and degeneration of the testes. However, due to the presence of some stromal cells, patients may have male external genitalia and appearance. It should be distinguished from bilateral cryptorchidism. The characteristics of this disease are increased luteinizing hormone (LH) in the blood, and the plasma testosterone level does not increase after administration of chorionic gonadotropin. Androgen should be administered regularly after puberty. Otherwise, a eunuchoid syndrome may occur, and testicular transplantation surgery can be performed, using sibling or allogeneic testicle transplantation. This disease often occurs with the absence of the vas deferens and epididymis.

　　2. Monorchidism. Most do not require special treatment, and the purpose of the surgical examination is to find out the possible presence of cryptorchidism in the abdominal cavity to prevent canceration.

　　3. Polyorchidism. Refers to the appearance of 3 or more testicles. Abnormal size.

　　4. The testicle is smaller than normal due to underdevelopment, and it is often not an isolated symptom.

　　5. Enlargement of the testicle due to hyperplasia, such as testicular teratoma.

　　6. Congenital atrophy. Abnormal position.

　　7. Testicular fusion. Refers to the fusion of both testicles into one body in the abdominal cavity or scrotum, which is easily mistaken for cryptorchidism or monorchidism. It often occurs with renal malformations.

　　8. Cryptorchidism.

　　9. Ectopic testicle.

　　10. Abnormal attachment of testicle and epididymis, which can cause obstacles in sperm production and lead to infertility. Poor connection between the two can easily lead to testicular torsion, and even tissue necrosis due to insufficient blood supply.

　　1. Congenital penile curvature:This is a malformation caused by the developmental disorder of the corpus cavernosum of the penis, with the penis bending towards the femoral side. Devine (1973) divided congenital penile curvature into three types according to the location and nature of the lesion tissue, namely: the absence of the corpus cavernosum of the urethra and the surrounding fascia, the maldevelopment of the Buck fascia and the adventitia, and the maldevelopment of the endometrium. The curvature of the absence of the corpus cavernosum of the urethra is the most severe. The main symptoms of patients with this disease are penile curvature, accompanied by urinary and sexual dysfunction. The main treatment method is to perform penile plastic surgery, including the excision of tissues that affect the straightening of the penis.

　　2. Phimosis and long foreskin:This is the most common congenital malformation of the male reproductive organ in clinical practice. Although both types of malformation have foreskin covering the penis, the foreskin of those with phimosis cannot be rolled up above the glans. The adhesion between the foreskin and the penis of newborns usually disappears naturally within 2 to 3 years after birth, which is a normal physiological phenomenon. Phimosis and long foreskin are often the causes of phimosis, calculus of the foreskin, leukoplakia of the penis, and penile cancer.

　　One, testicular deformities

　　1. Azoospermia. Rare, probably due to incomplete differentiation of the testicle during the embryonic development period, resulting in atrophy and degeneration of the testicle. However, due to the presence of some stromal cells, the patient may have male external genitalia and appearance. It should be distinguished from bilateral cryptorchidism. The characteristic of this disease is an increase in luteinizing hormone (LH) in the blood, and the plasma testosterone level does not increase after administration of chorionic gonadotropin. Androgen should be given regularly after puberty. Otherwise, androgenic eunuch syndrome may occur, and testicular transplantation surgery can be performed, using同胞兄弟 or allogeneic testicle transplantation. This disease often occurs with the absence of the vas deferens and epididymis.

　　2. Monorchidism. Most do not require special treatment, and the purpose of the surgical examination is to find out the possible presence of cryptorchidism in the abdominal cavity to prevent canceration.

　　3. Polyorchidism. Refers to the appearance of 3 or more testicles. Abnormal size.

　　4. The testicle is smaller than normal due to underdevelopment, and it is often not an isolated symptom.

　　5. Enlargement of the testicle due to hyperplasia, such as testicular teratoma.

　　6. Congenital atrophy. Abnormal position.

　　7. Testicular fusion. Refers to the fusion of both testicles into one body in the abdominal cavity or scrotum, which is easily mistaken for cryptorchidism or monorchidism. It often occurs with renal malformations.

　　8. Cryptorchidism.

　　9. Ectopic testicle.

　　10. Abnormal attachment of testicle and epididymis, which can cause obstacles in sperm production and lead to infertility. Poor connection between the two can easily lead to testicular torsion, and even tissue necrosis due to insufficient blood supply.

　　Two, vas deferens malformation

　　It can be divided into congenital absence, communication with the ureter, and multiple situations such as duplicated vas deferens. If there are no other malformations and only simple absence of the vas deferens, the patient's libido and sexual function are normal, the only symptom is infertility, and the clinical manifestation is azoospermia, but the serum hormone levels are all normal.

　　Three, penile abnormalities

　　1. Complete absence of the penis, often combined with urethral deformities.

　　2. Hidden penis, due to its short development, it is covered by fat in the perineum, scrotum, pubic bone, etc., and the penis is exposed as the fat decreases during the development process.

　　3. Congenital penile torsion, when the penis twists, the direction of the urethral opening changes, and some people may have symptoms such as hidden pain during erection, and this condition is also prone to combined with priapism.

　　4. Bifid penis, which can be arranged in parallel or in front and back.

　　5. Overly large or small penis, rare.

　　6. Phimosis, which can account for more than 25% of boys, can be divided into physiological phimosis, pseudo-phimosis (long prepuce), true phimosis, and paraphimosis.

　　7. Urethral fistula and urethral cleft, the latter is more common, the former is rare, and it can affect erectile function.

　　Four, congenital malformations of the prostate and seminal vesicle

　　1. Hypoplasia of the prostate often coexists with hypoplasia of other sexual organs, and prostatic cysts can be accompanied by difficulty in urination.

　　2. Absence of seminal vesicle, combined with infertility, can be initially diagnosed based on extremely low seminal plasma fructose levels and low semen volume, and confirmed by seminal vesicle vasography.

　　After genital plastic surgery, attention should be paid to protection:

　　1. Rest in bed after surgery, it is best to lie flat to avoid pressing on the reproductive organs.

　　2. Follow the doctor's instructions for medication change, use antiseptic drugs to prevent inflammation.

　　3. Take appropriate sedatives before going to bed for 2-3 months after surgery, and young people should also take ethinyl estradiol to prevent pain and bleeding caused by penile erection.

　　4. Keep the perineum clean. Some patients may have local discomfort around the prepuce after surgery, and scratching should be prohibited. Clean the area after urination and defecation to prevent local contamination.

　　5. Avoid sexual activity and masturbation before the wound heals after surgery. Stay away from sexual stimulation to avoid pain and bleeding during penile erection.

　　6. Avoid getting the surgical site wet within the first seven days after surgery.

　　7. After the anesthetic wears off, the wound may feel painful, and patients should not rush to take painkillers. Because aspirin and other drugs can worsen wound bleeding.

　　8. In case of abnormal conditions such as wound bleeding, seek medical help from the doctor in a timely manner.

　　9. Special care should be taken in nursing after different surgeries: such as pressure bandaging or using ice packs for local wound dressing after the operation of tunica vaginalis inversion.

　　1. Ultrasound.

　　2. Chromosome examination and gonadal examination, such as hypospadias.

　　3. Laparoscopic examination.

　　4. Preventive examination, in the course of work in the male infertility clinic or urology clinic, doctors often see a few patients with various congenital malformations that can cause male infertility. Although some of these congenital malformations are difficult to correct, some patients can be treated with early surgery if they are discovered in time during childhood. However, often due to a lack of knowledge in this area and the particularity of the reproductive system, people are often ashamed to mention it or afraid to go to the hospital for a check-up.

　　This leads to some patients missing the opportunity for treatment and having to bear lifelong regret. Currently, pre-marital examination is not普遍 in China. If a thorough examination is not conducted, it may affect the stability of marriage and the family. Therefore, I advise parents not to ignore careful observation of their sons' growth and development. Once a problem is found, the child should be taken to the hospital for examination as soon as possible.

　　Generally speaking, some congenital malformations only affect fertility, such as simple absence of the vas deferens; while some may also affect sexual function. Some malformations may not seem serious, such as phimosis, but improper treatment can still cause serious consequences. In summary, the treatment of various congenital malformations of the reproductive organs should be detailed and not coarse, early and not late, and one should never take it lightly.

　　1. Foods rich in vitamins B1, B2, and B6, such as beans, grains, and cheese, as well as foods rich in minerals such as zinc, magnesium, and manganese, such as oysters, nuts, spinach, and pumpkin.

　　2. Consume a variety of foods, high in protein, vitamins, calories, and easy to digest, such as animal liver, eggs, lean meat, dairy products, seafood, jujube, etc.

　　3. Pay attention to diet after surgery, avoid spicy food, alcohol, and刺激性食物. These can cause vascular congestion.

　　Precautions before the treatment of male reproductive organ malformations

　　The diagnosis of this disease is not difficult, but attention should be paid to distinguishing between orchidism and bilateral cryptorchidism. The characteristics of orchidism are increased luteinizing hormone (LH) in the blood and no increase in plasma testosterone levels after administration of chorionic gonadotropin.

　　Second, Western medical treatment methods for male reproductive organ deformities

　　1. Congenital absence of penis deformity:This disease is caused by incomplete development of the genital tubercle. Such patients not only have no penis but may also have other deformities of the urinary and reproductive systems, rectum and anus, cardiovascular system, and lower limbs. Therefore, patients often have a short life span. For patients who survive, the best treatment is to turn them into females, which includes operations such as orchidectomy and vulva shaping.

　　2. Hidden penis deformity:This disease is more common in people with an overweight body type (excluding those caused by varicocele). Patients often have abnormal penile development due to obesity, resulting in phimosis and small penile development, etc., which not only affects urination but also has a significant impact on sexual life. When diagnosing such patients, attention should be paid to distinguish them from those with small penis and those without a penis. The treatment method is comprehensive weight loss treatment, and in necessary cases, penile plastic surgery can be performed with the assistance of endocrine treatment. Children should try to complete the surgery before puberty.

　　3. Deformity of double penis:This condition is caused by developmental disorders of the penile primordium during embryogenesis and often accompanies other deformities, such as double bladder, double rectum, and deformities of the anus, spine, and other parts. Therefore, a comprehensive physical examination should be conducted for double penis deformity to make a comprehensive diagnosis. The treatment of simple double penis deformity is relatively simple, and it can be preserved on one side while the other side is excised.

　　4. Deformity of small penis:It is generally believed that the length of a newborn's penis is less than 1cm, and the length of the penis is less than 5cm after entering puberty, and the diameter is also small, but the urethra and orifice are normal, which is called a small penis deformity. The etiology is not very clear, and it may be one of the symptoms of other congenital deformities. Therefore, attention should be paid to whether the patient has gender畸形 and other congenital diseases of the endocrine and reproductive systems. Patients with small penis deformity often have poor development of secondary sexual characteristics, and the penis often has erectile dysfunction, and in severe cases, even urinary difficulties. Laboratory tests and pathological tissue examinations can be helpful for diagnosis. Treatment of such patients can be carried out according to the following principles:

　　(1) First, relieve the patient's difficulty in urination, and implement urethroplasty as soon as possible.

　　(2) Endocrine treatment should be carried out, and the earlier the androgen is used, the better the therapeutic effect.

　　(3) In necessary cases, small penis augmentation surgery or gender change surgery can be performed.

　　5. Deformity of large penis:The deformity of a large penis has both the length and diameter of the penis larger than those of a normal person. China has reported cases where the length of the penis reached 18cm, the root diameter reached 3.5cm, the glans length was 3.5cm, and the glans diameter reached 5.5cm. Patients with large penis deformity often also have other diseases of the endocrine system. Treatment for such patients usually involves partial resection of the corpus cavernosum to reduce the size.

　　6. Deformity of webbed penis:The webbed penis refers to a deformity where the skin of the penis is fully attached to the scrotum, causing the penis to be unable to erect and affecting urination. Some patients also have hypospadias or gender畸形. Treatment can be chosen according to specific circumstances, such as penile plastic surgery or hypospadias repair surgery.

　　7, The malformation of penile curvature:Congenital penile curvature is an abnormality caused by the developmental disorder of the penile corpora cavernosa, with the penis curving towards the femoral side. According to the location and nature of the pathological tissue, Devine (1973) divided congenital penile curvature into three types, namely: the absence of urethral corpora cavernosa and surrounding fascia, the maldevelopment of Buck fascia and adventitia, and the maldevelopment of the endometrium. The curvature of the absence of the urethral corpora cavernosa is the most severe. The main symptoms of this disease are penile curvature, accompanied by urinary and sexual disorders. The main treatment method is to perform penile plastic surgery, including the excision of the tissue affecting the straightening of the penis.

　　8, Phimosis and long foreskin:This is the most common male reproductive congenital malformation in clinical practice. Although the foreskin of both malformations covers the penis, the foreskin of those with phimosis cannot be flipped above the glans. The adhesion between the neonatal foreskin and the penis usually disappears naturally within 2-3 years after birth, which is a normal physiological phenomenon. Phimosis and long foreskin are often the causes of balanitis, phimosis stones, penile leukoplakia, and penile cancer. Abdominal hernia, urinary retention, and prolapse caused by phimosis can also be seen. In addition, it is also a cause of penile incarceration. Therefore, a positive treatment attitude should be adopted. Phimosis and long foreskin are usually corrected by surgery, and the treatment effect is relatively satisfactory. By the way, women also have the phenomenon of long clitoral prepuce. The clitoral glans is the most sensitive erogenous zone in women, so some people in foreign countries use clitoral prepuce circumcision to expose the clitoral glans as much as possible to improve the sexual sensitivity of women.

　　9, Hypospadias and epispadias:Hypospadias is a common male congenital malformation, with an incidence rate of about 1/6000. Many cases have a family history. The characteristics are incomplete development of the urethra, abnormal position of the urethral opening, and penile curvature towards the ventral side. The cause of its occurrence is not yet clear. From the perspective of embryology, it may be due to a disorder in the differentiation and development of the reproductive organs, that is, the fusion of the hypospadias and the urethral groove is obstructed, and the penile curvature is related to the obstruction of the corpora cavernosa development. It should be pointed out that in addition to causing hypospadias, reproductive organ differentiation and development disorders may also cause cryptorchidism, inguinal hernia, and other malformations, so it should attract the attention of medical personnel. In addition, many patients with hypospadias have chromosomal defects, indicating that the disease may be related to genetic factors.

　　For patients with hypospadias, the main difficulties are sexual and urinary, mainly due to the ectopic urethral opening and penile curvature. The pain and suffering in spirit and life coexist, so a positive treatment attitude should be adopted. The diagnosis of such patients is not very difficult. According to the different positions of the urethral opening, it can be divided into glanular type, penile type, scrotal type, and perineal type, and the degree of penile curvature can be divided into 1-3 levels according to the pathological tissue causing the curvature. The timing of the operation should be chosen before the age of school entry. The main purpose of the operation is to correct the painful erection and curvature of the penis, and at the same time, repair the urethra.

　　Urethral bifidity is a rare congenital anomaly, and its cause is also not fully understood. Clinically, it is divided into three types: glans type, penile type, and complete type (which may be accompanied by ectopia cystis). For these patients, surgery correction should also be performed in the pre-school period to prevent early death due to complications.

　　10. Congenital Anomalies of the Scrotum:Congenital anomalies of the scrotum are relatively rare, and the causes are not fully understood. They often coexist with other reproductive organ anomalies. According to literature reports, the main anomalies in the scrotal area include congenital absence of the scrotum, incomplete development of the scrotum, ectopic scrotum, and scrotal cleft, among others. The treatment methods are to choose different plastic surgery procedures according to the situation.

　　11. Congenital Anomalies of the Testes:Literature has reported the following testicular anomalies: polyorchidism, anorchism, syndactyly, microorchidism, and normal orchid, but these anomalies are very rare. The most common testicular anomaly is cryptorchidism. The mechanism of cryptorchidism is still not fully understood. In the early 20th century, Eccles proposed the famous ten-point factor theory, which is still the basis for studying cryptorchidism today. According to the data published by Campbell in 1959, the incidence of cryptorchidism in adults is about 0.28%. The most common location of testicular retention is the inguinal canal, followed by retroperitoneal, and rarely seen in other locations. Due to the difference between the location of testicular retention and the location of disease, the clinical manifestations of cryptorchidism are often diverse, and most patients may be discovered when they go to the hospital for lower abdominal pain or delayed development of secondary sexual characteristics. Currently, for the convenience of diagnosis, cryptorchidism is divided into five types, namely: incomplete descent of the testis, hypoplastic testis, hypopituitarism, atrophic testis, and ectopic testis. The main differential diagnosis is anorchism. Since cryptorchidism may affect the growth and development of patients and can cause severe psychological burden, it is also a cause or trigger of infertility, hernia, testicular torsion, testicular trauma, and malignancy. Therefore, early treatment should be adopted for cryptorchidism. Currently, most people believe that in addition to hormone therapy, surgery should be completed before school age.