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Undescended testicle (cryptorchidism)

Definition


Disease: Undescended testicle (cryptorchidism) Undescended testicle (cryptorchidism)
Category: Genito-urinary diseases

Disease Definition:

In case a testicle doesn’t move into its appropriate position in the scrotum, which is the bag of skin hanging behind the penis before the birth of a baby boy, it becomes known as an undescended testicle or cryptorchidism.

 

In baby boys who are born prematurely, or before 37 weeks, an undescneded testicle is more common. About 2 to 5% of boys are born with one or two undescended testicles, but having two undescended testicles is quite uncommon.

 

Usually, within the first few months of life, the undescended testicle corrects itself. However, surgery may be required to relocate the undescended testicle into the scrotum in case it doesn’t correct itself.  
 

Work Group:


Symptoms, Causes

Symptoms:

During fetal development, the testicles form in the abdomen. They leave the abdomen slowly during the last two months of normal fetal development; before descending into the scrotum, they pass through a tube-like passageway in the groin called the inguinal canal.

 

In case the process mentioned above is delayed or stopped at some point, the baby boy will have an undescended testicle. In this case, the undescended testicle won’t be seen or felt in the scrotum in its normal place.

 

Usually, an undescended testicle will be discovered during an exam shortly after birth. This problem won’t correct itself in case the testicle doesn’t move into the scrotum by the age of 4 months. Infertility and testicular cancer are some of the complications that can be avoided if the undescended testicle is treated during childhood.

 

There’s another condition in which boys, from infancy to preadolescence, may appear to be “missing” a testicle after being born with two normally descended testicles. This condition may be the result of:

  • An acquired undescended testicle or an ascending testicle, which has returned to the groin and can’t be easily guided back into the scrotum by hand.
  • A retractile testicle, a condition in which the testicle starts moving back and forth between the scrotum and the groin. In this case, during a physical examination, the testicle can be easily guided back into the scrotum.

 

The parents of baby boys with undescended testicles should ask the doctor how often they need to visit him/her. Additionally, the parents should talk to the doctor in case any changes are noticed in the genitals of their baby.
 

Causes:

Some of the factors that may disrupt the hormones, physical changes and the nerve activity that influence the development of testicles include maternal health, genetics as well as other environmental factors. However, the exact cause of this condition is still not known. Some of the conditions that may increase the risk of undescended testicles include:

  • Premature birth
  • Low birth weight
  • A family history of undescended testicle or other problems of genital development.
  • The mother’s use of alcohol during pregnancy
  • Exposure of the parents to some pesticides
  • An abdominal wall defect, Down syndrome or other conditions of the fetus that may hinder growth
  • Type 1 diabetes, type 2 diabetes or gestational diabetes in the mother
  • Mother’s exposure to secondhand smoke or smoking cigarettes
     

Complications

Complications:

The testicles should be somewhat cooler than the normal body temperature, so that they’ll be able to develop and function normally. This cooler environment is found in the scrotum. Additionally, the testicles undergo changes that affect the way they will function later, until a boy is three or four years old.

 

An undescended testicle may increase the risk of complications later in life because it isn’t in a cooler environment. Some of those complications may be:

Testicular cancer:

Men who have had an undescended testicle have an increased risk of developing testicular cancer. This type of cancer begins in the cells found in the testicle that produce immature sperm. However, it is still not known what exactly causes those cells to become cancerous.

Fertility problems:

Usually, men who have had an undescended testicle are more likely to have poor sperm quality, low sperm counts and impaired fertility.

Testicular torsion:

Men have an increased risk of testicular torsion in case they’ve had an undescended testicle. When the spermatic cord, which contains nerves, blood vessels as well as the tube that carries semen from the testicle to the penis, becomes twisted, it is a painful condition called testicular torsion. The blood to the testicle will be cut off due to this twisting, which may result in the loss of the testicle if not treated promptly.

Trauma:

A testicle may be damaged from pressure against the pubic bone in case it is located in the groin.

Inguinal hernia:

A part of the intestines may push into the groin in case the opening between the abdomen and the inguinal canal is too loose. This condition may be associated with an undescended testicle.
 

Treatments:

Moving the undescended testicle to its proper position in the scrotum is what treatment for this condition will focus on. As mentioned before, testicular cancer and infertility are some of the complications that can be avoided with early treatment.

 

SURGERY:

In most cases, an undescended testicle is corrected surgically. The undescended testicle will be carefully moved to the scrotum and stitched in its place. This surgery can be performed with laparoscopic devices and usually requires a relatively small incision. The health of the baby boy and the difficulty of the procedure are some of the factors on which the timing of the surgery will depend on. Because early surgical treatments usually lowers the risk of later complications, this procedure will be recommended after the baby boy becomes three to six months old and before he is 15 months old. In case the testicle contains dead tissue or is poorly developed or abnormal, it will be removed during this surgery. In some cases, the baby boy may have an inguinal hernia associated with the undescended testicle, which will also be repaired during this surgical procedure. In order to make sure that the testicle will continue to develop, function properly and stay in place, the testicle will be monitored after surgery through physical exams, tests of hormone levels and ultrasound examination of the scrotum.

 

HORMONE TREATMENT:

In this therapy, the baby boy will be injected with HCG (human chorionic gonadotropin). Scientists think that hormone treatment may lead to an early onset of puberty, a condition called precocious puberty. Although hormone treatment is not as effective as surgery, however, it can help the testicle move to the scrotum.

 

OTHER TREATMENTS:

Saline testicular implants for the scrotum can be considered in case one or both testicles of the baby boy didn't survive after surgery, or if they're missing. These are testicle-shaped nodules that are filled with a fluid and give the appearance of two testicles in the scrotum. They can be implanted either during late childhood or during adolescence. The baby boy will be referred to an endocrinologist (hormone specialist) in case he doesn't have at least one healthy testicle, in order to discuss future hormone treatments that are essential for physical maturity and puberty.
 

Prognosis:

Not available

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