Testicular deformity

　　Testicular deformity is a disease condition of orchitis caused by various pathogenic factors, which can be divided into non-specific, viral, fungal, spiral, parasitic, traumatic, and chemical types. Specific orchitis is often caused by the invasion of epididymal tuberculosis into the testicle and is very rare. The most common in clinical practice is non-specific orchitis and parotitis orchitis, which is one of the common causes of male infertility. The testicle is an important organ for maintaining male reproductive function and sexual characteristics. Both large and small testicles in adult males can affect fertility. For those who have been married for many years without children, it should be paid attention to. The size of testicular deformity is related to age, with the testicles in infants and children up to 12 years old being in a relatively static period, with a volume of about 1-4ml. Boys enter the pubertal period after 12 years old, and the volume of the testicles increases rapidly. The volume of adult male testicles is 16-25ml, with an average of 19.8ml. After 60 years old, the testicles enter the stage of sexual decline, and the volume gradually decreases. After 70 years old, the volume of the testicles can shrink to below 16ml. If the volume of an adult testicle is less than 10ml, it is considered small, and it can appear with low sexual function and male infertility.

　　Chronic orchitis is often caused by incomplete treatment of non-specific acute orchitis. It can also be caused by fungal, spiral, or parasitic infections, such as syphilis of the testicle. Those with a history of testicular trauma may develop granulomatous orchitis. Local or systemic phosphorus-32 radioisotope irradiation of the testicle can also cause orchitis and destroy testicular tissue.

　　Testicular deformity can easily cause the following diseases in clinical practice:

　　1. Epididymitis:The posterior margin of the testicle is the epididymis, where sperm are temporarily stored after production. Epididymitis is common in people around 30 years old, mostly due to testicular deformity and bacterial infection, causing bacteria to enter the epididymis through the lumen of the vas deferens. It often occurs with post-urethritis, prostatitis, seminal vesiculitis, and other conditions. The location can be unilateral or bilateral, and the onset can be acute or chronic.

　　2, Orchitis:It is often caused by the direct spread of orchitis or epididymitis to the testicle due to orchidomalacia, which is caused by bacteria. Acute orchitis in children is usually caused by the mumps virus. Since severe orchitis can cause the loss of fertility, doctors will use antibiotics in addition to painkillers; and cold compresses should also be applied to the testicle. If the doctor does not treat the acute stage properly, bacterial orchitis can form an abscess or become chronic orchitis.

　　3, Varicocele:The incidence of varicocele in men aged 30 to 40 is 10% of the total number of men. 90% of them occur on the left side, which is caused by the stasis of testicular venous blood, leading to the expansion, tortuosity, and elongation of the venous plexus. Varicocele may be caused by renal tumors. The reason why varicocele is worth attention is that it may be accompanied by testicular atrophy and congenital sperm disorders, leading to infertility.

　　4, Seminal vesicle cyst:Benign cysts in the testicle or epididymis, which are usually as large as a cube of sugar, are often humorously referred to as the third testicle. Fortunately, this situation is very rare. If you insist on removing these lumps, the doctor can remove them surgically for you. Avoid trauma to the testicle and scrotum. Have regular sexual life and avoid long-term sexual excitement.

　　Testicles secrete male hormones, which can stimulate the occurrence of sperm and the development of male accessory organs and secondary sexual characteristics. Therefore, whether it is congenital developmental disorders or postnatal factors causing testicular lesions, they can all lead to infertility. The testicle is the main sexual organ of males, whose function is to produce sperm. Sperm combines with egg to form a new individual, thus ensuring the continuity of the human race.

　　1, Abnormal position

　　Testicular fusion. It refers to the fusion of both testicles into one in the abdominal cavity or scrotum, which is easily mistaken for cryptorchidism or monorchidism. It often occurs with renal malformations. Cryptorchidism. Ectopic testicle. Abnormal attachment of the testicle and epididymis can cause obstacles in sperm production, leading to infertility. Poor connection between the two can easily lead to testicular torsion, and even tissue necrosis due to insufficient blood supply.

　　2, Abnormal size

　　The testicles are smaller than normal due to underdevelopment, which is often not an isolated symptom. The testicles become larger due to hyperplasia, such as teratoma of the testicle, congenital atrophy.

　　3, Abnormal quantity

　　Azoospermia. It is rare and is probably caused by incomplete differentiation of testicles due to certain reasons during the embryonic development period, leading to atrophy and degeneration of the testicles. However, due to the presence of some stromal cells, patients may have male external genitalia and appearance. It is important to differentiate 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 therapy should be regular after puberty. Otherwise, it may cause eunuchoid syndrome, and testicular transplantation surgery can be performed, using testicles from同胞 brothers or allografts. This disease often occurs with the absence of sperm ducts and epididymis. Unilateral testicle. Most do not require special treatment, and the purpose of the surgical examination is to find out the possible cryptorchidism in the abdominal cavity to prevent cancer. Multiple testicles. It refers to the presence of 3 or more testicles.

　　4, Symptoms of male pseudohermaphroditism:They are male by nature, but only have testicles, and their reproductive organs show female characteristics.

　　5, Cryptorchidism:The testicles of the fetus stop at any abnormal position during the descent process.

　　6. Absence of testicle syndrome:Incomplete or complete absence of the testicle.

　　7. Testicular inflammation:Some inflammation of the testicle, such as enlargement and bleeding, etc.

　　Attention should always be paid to changes in phimosis, paraphimosis, and concealed penis. Phimosis and paraphimosis can lead to the accumulation of smegma and urine in the prepuce cavity, causing balanoposthitis, producing purulent discharge and desquamation of the epidermis. In severe cases, it can cause ulcers or calculus formation on the prepuce and glans penis, causing narrowing of the urethral orifice and acute urinary retention. Severe narrowing of the external orifice of the penis can束缚 the development of the penis and affect fertility. Recurrent balanoposthitis can also make the patient irritable and neurotic. Middle-aged patients are prone to penile fibrous cavernous body inflammation plaques, which can easily develop into hidden penile fibrous cavernous body inflammation plaques, lose normal elasticity, and appear penile curvature. Once erect, it will not only be painful but also deformed, affecting normal sexual life and even causing impotence. Those who have persistent penile curvature and deformation for more than one year or whose plaques have calcified should seek surgery early.

　　Transposition of the penis and scrotum often complicates hypospadias. Hypospadias is a common urethral and genital deformity, and severe cases require chromosomal and gonadal examinations. Through surgery, the urethra is reconstructed to obtain a complete external genitalia. Penile torsion, where the glans penis deviates from the midline, can hinder sexual intercourse in severe cases and sometimes cause the patient to be unable to urinate normally. It can also affect the formation of the patient's healthy sexual psychology and normal social activities.

　　Congenital absence of the testicle, or loss of the testicle after injury, testicular torsion, testicular tumor, prostate tumor, testicular atrophy, urethral disease, penile deformation, and other conditions can cause corresponding symptoms, have a serious impact on the patient's psychology, or cause difficulties in reproduction, or even life-threatening situations. It is necessary to seek medical treatment in a timely manner to achieve: normal urination, ideal sex life, satisfactory appearance, and healthy sexual psychology.

　　Patients may have a slight increase in white blood cells during routine blood tests.

　　1. Doppler ultrasound examination shows a decrease in testicular blood flow.

　　2. Scintigraphy of the testicle with radioactive nuclide 99mTc (99mTc) shows reduced blood perfusion on the side of torsion, presenting as a radioactive cold area, with a diagnostic accuracy rate of 94%, and is universally recognized as the most reliable auxiliary diagnostic measure.

　　Ultrasound examination and CT scan are helpful in determining whether the testicle is swollen, acute hydrocele, scrotal edema, and incarcerated hernia, but they are unreliable in distinguishing testicular torsion from epididymitis.

　　For patients with posteriorly formed testicular deformities and pathological characteristics of testicular deformity, patients with testicular deformity should pay attention to dietary protection while receiving medical treatment.

　　1. Do not take Western medicine arbitrarily:Many cancer patients regard Western medicine's vitamins as the treasure of strengthening the body. In fact, they are toxic because they are chemically synthesized. Western medicine has sufficient evidence to show that chemically synthesized vitamins can cause damage to internal organs. It is advisable to consume natural vitamins, such as vegetable juice and fruit juice.

　　2. Do not eat tonics randomly:Such as Cordyceps sinensis, ginseng,鹿茸精, Osmanthus, Astragalus, Ligustrum lucidum, American ginseng. Do not randomly inject interferon, thymosin, and other tonics. Some people think that these drugs can make themselves strong. Wrong! These drugs can promote you to consume. They can promote the rapid growth and metastasis of tumors in cancer patients.

　　3. Do not eat high-iodine foods:Patients ate seafood, such as: crabs, shrimps, eels, seaweed, etc., including iodine-added foods and iodized salt, the tumor will溃破.

　　The testis is an important organ for maintaining male reproductive function and sexual characteristics. The treatment methods for testicular malformation include the following:

　　1. Congenital absent penis deformity

　　Caused by incomplete development of the genital tubercle, such patients may also have other urogenital, rectal and anal, cardiovascular system, and lower limb malformations. Therefore, patients are often short-lived. For those who can survive, the best treatment is to become female, and the surgery includes orchidectomy and vulva shaping, etc.

　　2. Hidden penis deformity

　　It is more common in people with obesity (excluding those caused by hydrocele), and patients often have abnormal penile development due to obesity, leading to phimosis and shortening of the penis. In addition to affecting urination, it also has a significant impact on sexual life. When diagnosing such patients, attention should be paid to differentiate from those with small penis and absent penis. The treatment method is comprehensive weight loss therapy, and it may be necessary to perform penile整形术 and auxiliary endocrine therapy. Children should try to complete the surgery before puberty.

　　3. Double penis malformation

　　This condition is caused by the developmental disorder of the penile primordium during embryogenesis and often is associated with other malformations such as double bladder, double rectum, and malformations of the anus, spine, and other parts. Therefore, a comprehensive physical examination should be performed for patients with double penis malformation to make a comprehensive diagnosis. The treatment of simple double penis malformation is relatively simple and can retain one side that is more robust and excise the other side.

　　4. Small penis deformity

　　Generally, it is considered that the length of a newborn's penis is less than 1 cm, and after puberty, the length of the penis is less than 5 cm, and the diameter is also smaller, but the urethra and opening are normal, which is called a small penis deformity. The etiology of the disease is not very clear, and it may be one of the symptoms of other congenital malformations. Therefore, attention should be paid to whether the patient has gender malformation and other congenital malformations of the endocrine and reproductive systems. Patients with small penis deformity often have poor development of secondary sexual characteristics, and many have erectile dysfunction. Severe cases may even have difficulty urinating. Laboratory tests and pathological tissue examinations are helpful for diagnosis. Treatment of such patients can be carried out according to the following principles:

　　5. Penile curvature deformity

　　Congenital penile curvature is a deformity caused by the developmental disorder of the corpora cavernosa, in which the penis is curved towards the thigh side. Devine (1973) classified congenital penile curvature into three types based on the location and nature of the lesion, namely: the absence of the urethral corpora cavernosa and surrounding fascia, the underdevelopment of the Buck fascia and tunica albuginea, and the underdevelopment of the endometrium. The curvature in the absence of the urethral corpora cavernosa is the most severe. The main symptoms of this disease are penile curvature, accompanied by urination and sexual dysfunction. The main treatment method is to perform penile整形术, including the excision of tissues that affect penile straightening.

　　6. Phimosis and long foreskin

　　This is the most common clinical congenital malformation of male reproductive organs. Although both malformations have foreskins that cover the penis, those with phimosis cannot roll the foreskin over the glans. The adhesion between the neonatal foreskin and penis 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 balanitis, phimosis calculus, penile leukoplakia, and penile cancer. Abdominal hernia, urinary retention, and rectal prolapse can also occur due to phimosis. It is also a cause of penile incarceration, and therefore, a positive treatment attitude should be adopted. Phimosis and long foreskin are usually corrected by surgery, and the therapeutic effect is relatively satisfactory. Incidentally, women also have the phenomenon of long clitoral hood. The clitoral glans is the most sensitive erogenous zone in women, and therefore, some people in foreign countries use clitoral hoodectomy to expose the clitoral glans as much as possible to increase female sexual sensitivity.

　　Testicular infertility is extremely rare when the testicles are absent. Anorchidism can be divided into three categories:

　　(1) The testicles are absent.

　　(2) Part of the testicles, epididymis, and vas deferens are absent.

　　(3) The testicles, epididymis, and vas deferens are all absent.

　　The etiology is not yet clear, and it may be due to the destruction of the testicles by toxins in the embryonic period or secondary to testicular atrophy caused by vascular occlusion and trauma. Unilateral anorchidism often occurs on the right side and is often accompanied by contralateral cryptorchidism. Bilateral anorchidism often leads to gender abnormalities and associated with eunuchoidism due to the lack of interstitial cells that secrete male hormones. There are also some individuals without eunuchoidism, who may have ectopic interstitial cells. The testicles are the main sexual organs in males, and their function is to produce sperm, which combine with eggs to form a new individual, thus ensuring the continuity of the human race. Additionally, they also secrete androgens, which can stimulate spermatogenesis and the development of male accessory organs and secondary sexual characteristics. Therefore, whether it is congenital developmental disorders or lesions caused by numerous factors in later life, they can all lead to infertility.

　　The size and texture of the testicles, from birth to before the puberty at 12 years old, the testicles are in a relatively static period, generally with a volume of 1 to 4 milliliters; thereafter, the volume of the testicles increases rapidly, the volume of the testicles in adult males is 16 to 25 milliliters, with an average of 19.8 milliliters; after the age of 60, the volume of the testicles gradually decreases. If the volume of the testicles in men of childbearing age is less than 15 milliliters, it indicates damage to the seminiferous tubule spermatogenic epithelium. Small testicles with a volume not exceeding 3 milliliters are often seen in Klinefelter's syndrome; patients with testicle size between 5 to 12 milliliters may have hypogonadotropic hypogonadism; when the testicles are asymmetrical and significantly enlarged, it suggests the presence of testicular tumors; when the testicles are symmetrically enlarged, it can be called macroorchidism, which is normal but less common. The texture of the testicles should also be paid attention to. The normal testicles have elasticity when lightly pressed, and if the testicles feel soft when lightly pressed, it is often accompanied by damage to the spermatogenic function, which can affect male fertility and should be treated promptly.

　　The determination of diagnosis mainly should be differentiated from cryptorchidism, especially in bilateral anorchidism. Bilateral anorchidism generally lacks sexual function, while cryptorchidism can still maintain male sexual function. The determination of blood testosterone levels can assist in differential diagnosis, the method being a single injection of chorionic gonadotropin 5000U, after which the testosterone level of cryptorchid patients will rise significantly, and if there is a chromosomal abnormality, it should be considered as gender dysmorphia.

　　When there is no testicle, since there are no stromal cells that secrete androgens and no germ cells, there is no fertility. After clear diagnosis, the main treatment is to reasonably and timely supplement androgens to ensure that the patient's external genitalia develop well. However, if androgens are used too early, it can cause the epiphyses to close and affect physical development. During the medication period, the level of testosterone should be measured regularly to adjust the drug dosage. The 'artificial testicle' implantation surgery can安抚 the patient's psychological inferiority complex to a certain extent, reduce psychological trauma.

　　The traditional method of reconstructing the testicle with artificial testicles is to implant hard or sac-like silicone testicles into the scrotum. However, this method can only make up for the shortcomings in appearance. Every three to four weeks after the operation, it is necessary to inject androgens once to maintain male secondary sexual characteristics, which is indeed a troublesome and painful thing for people who have received artificial testicle reconstruction. When a male lacks one testicle or both testicles are missing due to some reason, the psychological and physiological needs will require doctors to perform testicular plastic surgery to achieve coordination and unity between appearance and function. The Department of Medicine at Gunma University in Japan has successfully developed an artificial testicle that can 'secrete' androgens, which has been successfully applied in clinical practice. This new type of artificial testicle with 'secretion' function is made by mixing liquid high molecular compounds with testosterone and then solidifying and shaping it under a temperature of -78 degrees Celsius by radiation.

　　The doctors in plastic surgery implant this high molecular compound containing androgens, which is a silicone solid, into the scrotum of the human body. Due to the use of sustained-release technology, this artificial testicle can continuously release male hormones slowly. After biochemical examination of the blood, the level of male hormones in the patient's blood can reach the standard of adult males. The 'secretion' function of this artificial testicle can last for several years, and it can be used to adjust the 'secretion' amount of the artificial testicle by changing the formula of the high molecular compound. Therefore, it is very popular with patients, and in addition to its simple manufacturing process, the pharmacological effect can be fully exerted, the side effects are small, and the operation can be completed in one operation during the testicular shaping operation, which is a relatively ideal artificial testicle.