Overview
Undescended testicle (cryptorchidism) is a testicle that hasn't moved into its proper position in the bag of skin hanging behind the penis (scrotum) prior to the birth of a baby boy.
About 2 to 5 percent of baby boys are born with one or two undescended testicles. An undescended testicle is more common among baby boys born prematurely, or before 37 weeks. It's rare for boys with cryptorchidism to have two undescended testicles.
For most boys born with one or two undescended testicles, the problem corrects itself within the first few months of life. If your infant has an undescended testicle that doesn't correct itself, surgery can usually be used to relocate it into the scrotum.
When To See A Doctor ?
An undescended testicle is typically detected when your baby is examined shortly after birth. If your son has an undescended testicle, ask the doctor how often your son will need to be examined. If the testicle hasn't moved into the scrotum by the time your son is 4 months old, the problem probably won't correct itself. Treating undescended testicle when your son is still a baby may lower the risk of complications later in life, such as infertility and testicular cancer.
Older boys — from infants to preadolescent boys — who have normally descended testicles at birth may appear to be "missing" a testicle later.
This condition may indicate :
- A Retractile Testicle, which moves back and forth between the scrotum and the groin and may be easily guided by hand into the scrotum during a physical examination
- An Ascending Testicle, or acquired undescended testicle, which has "returned" to the groin and cannot be easily guided by hand into the scrotum
If you notice any changes in your son's genitals or are concerned about his development, talk to your doctor.
Causes
The exact cause of an undescended testicle isn't known. A combination of genetics, maternal health and other environmental factors may disrupt the hormones, physical changes and nerve activity that influence the development of the testicles.
Risk factors
Conditions that may increase the risk include:
- Low birth weight
- Premature birth
- Family history of undescended testicle or other problems of genital development
- Conditions of the fetus that can restrict growth, such as Down syndrome or an abdominal wall defect
- Alcohol use by the mother during pregnancy
- Cigarette smoking by mother or exposure to secondhand smoke
- Diabetes in the mother — type 1 diabetes, type 2 diabetes or gestational diabetes
- Parents' exposure to some pesticides
Complications
An undescended testicle isn't in a cooler environment. This might increase the risk of complications later in life.
These complications include:
- Testicular cancer. Testicular cancer usually begins in the cells in the testicle that produce immature sperm. What causes these cells to develop into cancer is unknown. Men who've had an undescended testicle have an increased risk of testicular cancer.
- Fertility problems. Low sperm counts, poor sperm quality and impaired fertility are more likely to occur among men who have had an undescended testicle.
Other complications related to the abnormal location of the undescended testicle include:
- Testicular torsion. Testicular torsion is the twisting of the spermatic cord, which contains blood vessels, nerves and the tube that carries semen from the testicle to the penis. This painful condition cuts off blood to the testicle. If not treated promptly, it may result in the loss of the testicle. An undescended testicle increases the risk of testicular torsion.
- Trauma. If a testicle is located in the groin, it may be damaged from pressure against the pubic bone.
- Inguinal hernia. An undescended testicle may be associated with an inguinal hernia. If the opening between the abdomen and the inguinal canal is too loose, a portion of the intestines can push into the groin.
Treatment of Cryptorchidism
Treatment for cryptorchidsm includes both medical (hormonal) and surgical approach separately or in combination with one another. Procedures are usually completed between 6 and 24 for months of age for the best outcomes.
Medical Treatment:
Increasing the level of the male sex hormone testosterone can increase the likelihood that undescended testicles will move into the scrotum. This is done by either giving injections of human chorionic gonadotropin (hCG) or gonadotropin releasing analog (not approved in the United States). Both cause the testes to produce testosterone. The approach is most likely to work if the testes are already low and are not blocked or actually just retractile. Retractile testicles are sometimes in the scrotum or sometimes in the inguinal canal. This approach results in descent of 5-25% with about 25% of those for whom the treatment work relapsing.
Surgical Treatment:
The first step is to confirm the location of the testes (often can be felt in the inguinal canal). If a boy has non-palpable testicles, he may need exploratory surgery to determine if testes are present. In some cases, testes are completely absents (about 1/10 boys with undescended testicles). Consequently, diagnostic laparoscopy is often used first in these boys confirm the presence of testes before a full inguinal incision is made for the full orchiopexy. Once the location of the testes in confirmed, surgeons will perform the full procedure.
Orchiopexy is a surgical procedure that secures the proper position of a testicle in the scrotum. When successful, orchiopexy decreases the risk of sterility, testicular cancer, and testicular injury from abnormal positioning. If a testicle is missing or must be removed, a prosthesis is inserted to achieve a normal appearance and to foster the person's positive body image. Orchiopexy for correction of an undescended testicle is usually performed in children ages 1 to 6.
Orchiopexy is performed when other treatments such a hormonal therapy fail. It is performed under general anesthesia. If there is testicular torsion (twisting), the surgeon makes an incision in the scrotal skin and attempts to untwist and stabilize the spermatic cord. To treat an undescended testicle, the surgeon makes an incision in the groin or lower abdomen to expose the testicle and a small incision to open the scrotum. He or she then frees the testicle, lowers it into the scrotal sac, and secures it with stitches. If both testicles are undescended this procedure is repeated for the other testicle.
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