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Monorchism

 
, medical expert
Last reviewed: 04.07.2025
 
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Monorchism is a congenital anomaly characterized by the presence of only one testicle.

In monorchism, along with the absence of the testicle, the epididymis and vas deferens do not develop. The corresponding half of the scrotum is hypoplastic.

Causes monarchism

Monorchism can be either acquired (e.g., trauma, torsion of the spermatic cord) or congenital (disruption of embryogenesis before the formation of the final kidney and sex gland - renal agenesis). Often, a combination of monorchism and solitary kidney is found.

Symptoms monarchism

The child's parents complain of the absence of a testicle in the scrotum since birth. During examination and physical examination, hypoplasia of half of the scrotum is noted, the testicle in the scrotum and inguinal canal is not palpated.

Ultrasonography also reveals the absence of a testicle in the scrotum and inguinal canal. However, at this stage, a diagnosis of monorchism cannot be made. Angiography and diagnostic laparoscopy are methods that can confirm monorchism.

Angiography reveals that the testicular vessels end blindly, and there is no capillary or venous phase of testicular contrast.

Diagnostic laparoscopy is the most informative method for determining the presence or absence of a testicle in the abdominal cavity. In case of testicular agenesis, hypoplastic, blind-ending testicular vessels and the vas deferens are necessarily determined, while the internal inguinal ring is closed.

Forms

QS5.0. Absence and aplasia of testicle.

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Treatment monarchism

Conservative treatment

Monorchism with a normal second testicle usually does not manifest itself in endocrine disorders and does not lead to infertility. However, monorchism caused by testicular agenesis should be diagnosed using an endocrinological examination - determination of the content of luteotropic hormone (LH), follicle-stimulating hormone (FSH), testosterone. With a decrease in testosterone concentration (hypogonadism), replacement therapy with testosterone preparations is indicated.

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Surgical treatment

It is necessary to clearly define the signs of testicular agenesis. In some cases, laparoscopic revision of the abdominal cavity reveals testicular vessels that go together with the ductus deferens into the inguinal canal. If the internal inguinal ring is open, hypoplasia of the cryptorchid testicle is most likely. If the internal inguinal ring is closed, there is a high probability of testicular aplasia. In this case, revision of the inguinal canal and removal of the hypoplastic testicle are indicated. The operation is performed at the age of 14 years simultaneously with the implantation of a silicone prosthesis.

In case of monorchism of any etiology, boys undergo testicular prosthetics with a silicone implant at puberty age. The operation is performed via transscrotal access. The size of the implant is determined by the size of the second testicle.

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