Cryptorchidism

The testes or testicles are male reproductive organs that produce sperm and male sex hormones. Testes normally develop inside the abdomen during fetal development and gradually move into the scrotum, the sac hanging below the penis, through a passage in the groin before birth.

Cryptorchidism, also referred to as undescended testicles, is a condition where one or both testicles fail to move from the abdomen into the scrotum by the time of birth.

The position of the scrotal sac outside the body provides a cool, ideal environment for normal physiological functioning. In cryptorchidism, high internal body temperature may cause dysfunction of the undescended testis.

Causes.

Cryptorchidism is a rare condition but is more common in premature and underweight babies. The exact cause is unknown, but it may be influenced by certain factors such as genetics, exposure to certain chemicals, substance abuse during pregnancy and maternal health conditions, such as diabetes and obesity. These can affect hormone levels and fetal development.

Symptoms.

Children with undescended testicles do not exhibit any symptoms other than the absence of one or both testicles in the scrotum.

Sometimes, a boy born with normal descended testicles may experience a retractile testicle, where the testicle moves back and forth, or an ascending testicle, where the testicle returns back to the groin.

If left untreated, cryptorchidism can lead to:

Fertility problems.

testicular cancer.

twisting of the spermatic cord (testicular torsion).

inguinal hernia.

trauma to the undescended testes.

Diagnosis.

Undescended testes may be diagnosed before birth on a prenatal ultrasound but is usually found on the initial physical examination of the baby just after birth. This will be done by touch or palpation in the groin area. If the testes are not palpable, imaging techniques such as an ultrasound or CT scan are used to determine the location of the testicles. Sometimes, the location of the testicles is investigated by laparoscopy where a thin lighted tube with a camera is inserted through a small incision in the abdomen or sometimes with open surgery (through a larger incision).

Treatment.

Undescended testes generally move down into the scrotum naturally by the time the child is 3-6 months old. In other situations, treatment may be necessary to prevent future risk of injury, infertility or cancer.

Conservative treatment.

Your child may be treated conservatively with hormone injections to bring the testicle down into the scrotum.

Surgical treatment.

If hormone therapy does not help, then surgery may be indicated. Surgery to treat cryptorchidism is usually performed at the age of 3 to 6 months through orchiopexy or orchiodectomy.

Orchiopexy is conducted under general anesthesia, in an outpatient setting. It can be performed by open surgery with a larger incision or by minimally invasive laparoscopy, where a narrow lighted tube with a camera is inserted through a tiny incision to give your child’s surgeon a clear view of the surgical site.

At first, the location of the undescended testicle is identified. One small incision is made in the groin to access the testicle. The testicle is normally suspended in the scrotum by an artery. An abnormally short artery sometimes leads to an undescended testicle. During orchipexy, the artery is freed from the surrounding tissues so that it can stretch to its full length. Next, a small incision is made in the scrotum to draw the testicle down. The position is secured with stitches and the incisions are closed.

Orchidectomy is a surgery to remove one or both testicles. It is recommended in children in the following situations:

When wasting of the testis occurs after orchidopexy,

when the spermatic cord gets twisted (testicular torsion),

when blood supply to the testis gets cut off

and in cases of small dysplastic (abnormal) undecended testicles.

The surgery is performed under general anesthesia. Your child’s surgeon makes a small incision in the groin area on the affected side of the testicle and removes the testicle and spermatic cord. The incision is then closed with stitches.

Post-operative care.

Following either surgery, basic post-operative instructions include:

Aadequate rest and a nutritious diet to promote healing.

Avoid sports, rough playing, bike riding, or any activity that could injure the groin area for the first two weeks after surgery.

Report any signs of infection such as fever, chills, or redness or drainage from the incisions promptly to your surgeon.

Risks and complications.

Orchidopexy and orchidectomy are usually safe, but some of the possible risks and complications include:

Bruising.

Swelling.

Bleeding.

Infection.

Damage to blood vessels or other surrounding structures.

Return of the testicle into the groin following orichidopexy.

Altered genital appearance following orchidectomy.

Cryptorchidism or undescended testicles is a condition where one or both testicles fail to descend into the scrotum by the time of birth. Treatment is necessary in order to avoid fertility problems and other complications. If the testicles do not descend into the scrotum within a few months of birth, hormone injections are given initially. If this conservative treatment is unsuccessful, surgery is then recommended.