CASTRATION

From Big Medical Encyclopedia

CASTRATION (Latin. castratio) — the influence causing the complete and irreversible cessation of function of gonads (gonads). Surgical removal of gonads (gonadectomia, orchidectomia, ovarioectomia), the x-ray radiation, an injury or an infection which are followed by full destruction of tissue of gonads are among such influences. Unilateral loss of a gonad; (hemicastration) is not To., since the remained gland compensates function lost. Eunuch (synonym: eunuch, skopets, holoshcheny, etc.) — the person who lost for any reason anatomically or functionally both gonads.

To. causes in a human body development of a certain symptom complex, form of manifestation to-rogo and degree of manifestation depend on age, in Krom it is made To. The changes arising later To., are entirely connected with the termination of endocrine function of gonads. According to modern representations, in cytoplasm of cells of hormonedependent bodies there are specific receptor proteins which connect the hormones coming to fabric. The formed gormonoretseptorny complexes are transferred from a kernel of cells and enter interaction with certain sites of the chromosomal device. Stimulation of protein synthesis is caused by activation of the relevant genetic structures that finally leads to development adequate biol, effect. Existence of separate proteins receptors for estrogen, androgens and other sex hormones is established, and these receptor systems are present at the same time at gormonochuvstvitelny fabrics. Later To. in these bodies receptor proteins remain, and, therefore, ability of an organism to react to hormones does not disappear.

As the sexual differentiation of an organism is regulated by sex hormones, To. at children's age is followed by the greatest disturbances: characteristic deformation of a skeleton, lack of development of secondary sexual characteristics at pubertal age, obesity, osteoporosis, etc. (see. Eunuchoidism ). To. at reproductive age causes a deseksualization (a hypotrophy of secondary sexual characteristics), development of a number of the exchange and vegetovascular disturbances characteristic for postkastratsionny syndrome (see). To. in the late period of a climax and in the period of a menopause is not followed by essential changes in an organism since by this time endocrine function of gonads dies away.

Thanks to a superficial arrangement of gonads To. men it was known already in an extreme antiquity (e.g., To. slaves — attendants of harems). Example ritual To. was To. at members of Christian sect of skopts.

Surgical To. women began to practice since the end of 19 century; widely resorted to it at various diseases of a uterus and appendages, at uterine bleedings, the expressed forms of a neurasthenia, epilepsy, circulator psychosis, hysteria. After establishment by L. L. Okinchits in 1906 x-ray radiation of its steel widely to apply possibilities of suppression of function of ovaries at treatment of the hysteromyomas which are followed by bleeding, endometriosis, a breast cancer. In the subsequent it was found out that switching off of function of gonads leads to essential disturbances of activity of many bodies and systems, and indications to To. were sharply limited.

To. treats the category of mutilating interventions, and indications to it shall be medical and are legally reasoned and documented. Any gonad operation shall be most sparing. Is absolutely unacceptable for the Soviet medicine To. on the basis of legal or religious reasons, and also at patients with psychological frustration.

Surgical castration of men (orchidectomy)

Indications: malignant tumors of testicles, extensive inflammatory defeats with destruction of a parenchyma of testicles, crush of testicles, malignant tumors of a prostate.

Technology of operation: from a side scrototomy or a section in the field of an outside opening of the inguinal channel in a wound dislocate a small egg with its covers; on the directing linking of a small egg (guberna culum testis) impose clips, cross it, allocate a seed cord and cross all its elements between clips together or separately, allocating its elements; the small egg is deleted together with covers or separately (enucleation): the wound is taken in layer-by-layer. Operation becomes complicated at an arrangement of a small egg in the inguinal channel or in an abdominal cavity, and also in need of expanded excision of surrounding fabrics or simultaneous plastics of the inguinal channel. At malignant new growths of testicles at the same time make excision regional limf, nodes.

Postkastratsionny therapy: during the bilateral surgical removal of testicles which is not connected with tumoral process surely appoint a replaceable androgenoterapiya for prevention of development of a postkastratsionny syndrome.

Surgical castration of women (ovariektomiya)

Indications: malignant new growths of ovaries, torsion of an ovary with a necrosis, malignant tumors of estrogenochuvstvitelny bodies — milk leu, a uterus, vaginas, vulvas.

Technology of operation: after opening of an abdominal cavity nizhnesredinny or cross (across Pfannenshtil) a section on ligaments of ovaries impose clips and ovaries cut, clips replace with catgut ligatures which immerse in leaves of a wide sheaf. More often along with ovaries delete also pipes, i.e. make an adnexectomy of a uterus. On voronkotazovy ligaments, own ligaments of ovaries and a uterine corner of a pipe impose clips then appendages cut. Vessels alloy and stumps immerse in leaves of a wide sheaf. For peritonization it is possible to use also round ligament of a uterus. Postkastratsionny treatment: replacement therapy by sex hormones is obligatory in all cases behind an exception To., made concerning gormonochuvstvitelny tumors and during removal of ovaries at elderly people. Replaceable hormonal therapy allows to avoid development of a postkastratsionny syndrome, involution of secondary sexual characteristics, especially at To. at children's age.

Beam castration with to lay down. the purpose make extremely seldom and only at women. Indications — endometriosis of rectovaginal cellulose at women are more senior than 45 years when hormonal therapy does not render effect, there is pain and operation can be extremely traumatic. At radiation therapy of cancer of uterus also there comes switching off of function of ovaries.

Hormonal castration

It is necessary to distinguish from To. the temporary and reversible switching off of function of gonads caused by administration of hormonal drugs at Krom happens braking of gipotalamo-pituitary mechanisms of regulation of reproductive system. Hormonal therapy is applied in the presence of contraindications to surgical To., and also to women at uterine bleedings in a late climacteric and in a menopause. For this purpose use male sex hormones, synthetic progestins, high doses of estrogen. Introduction of large amounts of heterosexual hormones can be followed by undesirable effect (at women — virilescence, at men — feminization).

See also Small egg , Ovaries .



Bibliography Gynecologic endocrinology, under the editorship of K. N. Zhmakin, page 210, M., 1976, bibliogr.; Dobrotinaa. T., Zagryadskaya L. P. and Hamadya-n about in U. R. Dysfunctional uterine bleedings, M., 1972, bibliogr.; The chosen lectures on transplantation, under the editorship of I. D. Kirpatovsky, M., 1969, bibliogr.; To Milk of Piece and Denile-M at with t of e r And. Gynecologic endocrinology, the lane from Romanians., Bucharest, 1973; Molnar E. The general spermatology, the lane with it., Budapest, 1969, bibliogr.; Persianinov L. S. Operational gynecology, M., 1976, bibliogr.; The guide to clinical endocrinology, under the editorship of V. G. Baranov, L., 1977, bibliogr.; Chukhriyenko D. P. and Lyulko A. V. The atlas of operations on bodies of urinogenital system, M., 1972, bibliogr.

I. V. Golubeva, G. M. Savelyev.

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