Monarchism
Last reviewed: 23.04.2024
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Monochrism is a congenital anomaly characterized by the presence of only one testicle.
With monarchism, along with the absence of a testicle, the appendage and the vas deferens do not develop. The corresponding half of the scrotum is hypoplastic.
Causes of the monarchism
Monochromism can be either acquired (for example, trauma, torsion of the spermatic cord), and congenital (embryogenesis disturbance before laying the final kidney and sex gland - renal agenesis). Often there is a combination of monarchism and a solitary kidney.
Symptoms of the monarchism
Parents complain about the lack of testicles in the scrotum since birth. On examination and physical examination, hypoplasia of the half of the scrotum is noted, the testicle in the scrotum and inguinal canal are not palpable.
When ultrasonography is also noted the absence of testicles in the scrotum and inguinal canal. However, at this stage it is impossible to diagnose "monarchism". Methods to confirm monarchism are angiography and diagnostic laparoscopy.
When angiography is determined that the testicles end blindly, there is no capillary and venous phase of the testicle contrast.
Diagnostic laparoscopy is the most informative method for determining the presence or absence of a testicle in the abdominal cavity. In the case of agenesis, the testicles are determined by the gipolarized, blindly terminating testicular vessels and the vas deferens, while the inner inguinal ring is closed.
Forms
QS5.0. Absence and aplasia of the testicle.
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Treatment of the monarchism
Conservative treatment
Monochrism with a normal second testicle is usually not manifested by endocrine disorders and does not lead to infertility. However, monochromism caused by testicle agenesis should be diagnosed by endocrinological examination - the determination of the content of luteotropic hormone (LH), follicle-stimulating hormone (FSH), testosterone. With a decrease in testosterone concentration (hypogonadism), substitution therapy with testosterone preparations is indicated.
Surgery
It is necessary to clearly identify the signs of testicular agenesis. In some cases, with a laparoscopic revision of the abdominal cavity, testicular vessels are found that go with the ductus deferens into the inguinal canal. If the inner inguinal ring is open, hypoplasia of the cryptorchied testicle is most likely. If the inner inguinal ring is closed, the probability of aplasia of the testicle is high. In this case, audit of the inguinal canal and removal of the hypoplastic testicle are shown. The operation is performed at the age of 14 years at a time with the implantation of a silicone prosthesis.
With the monarchism of any etiology, boys in pubertal age are provided with prosthetic testicles with a silicone implant. The operation is performed by over-night access. The size of the implant is determined by the size of the second testicle.