Cryptorchidism
Also known as: absent testicle
See Also:
Undescended Testicles
What is it?
Cyptorchidism, or undescended testicles, is a
congenital condition of infant males characterized by one
or both testicles that haven’t moved into the scrotum by
birth. The testicles begin inside the abdominal cavity
and, usually before birth, push through the groin tissue
forming a scrotal sac. Occasionally, one or both testes do
not descend into the scrotum by birth but may come down
later.
Who gets it?
Approximately 3 percent of full term male newborns have an undescended testicle at birth, and up to 30 percent of
premature males newborns have at least one undescended
testicle. In over 50% of these patients, the testes
descend by the third month, and by age one, 80% of all
undescended testes have descended into the scrotum.
Further descent may occur through puberty.
What causes it?
Abnormal testicular development usually causes
cryptorchism. The affected testicles frequently have
a short spermatic artery, poor blood supply, or both. Since the
testicles typically descend late in fetal development,
during the eighth month of gestation, the infant born
before this time has a greater chance of having cyptorchidism.
What are the symptoms?
The major symptom of cryptorchidism is not being able
to feel one or both of the testicles in the scrotum. The
testicles appear to be either missing or lopsided. If your doctor can't feel the testicles inside
the scrotum, it's called a "nonpalpable" testicle.
Cryptorchidism can cause other complications, including
infertility and testicular cancer. It is reported that
changes in an undescended testicles occur as early as six
months of age, with the reported cancer rate in
cryptorchism at 22 times higher than in the general
population.
How is it diagnosed?
Early diagnosis and management of cryptorchism is
needed to preserve fertility and improve early detection
of testicular cancer. To diagnose cryptorchidism, the
doctor, usually an urologist, may palpate the scrotum and
abdomen to locate the testicles while the patient is in
the squatting position or in a warm bath. The doctor may
also test plasma testosterone concentrations to confirm
the presence or absence of abdominal testicles. If one or both
testicles cannot be detected, there is no need for
immediate concern, since they usually drop into place on
their own later. Presence of undescended testes can also
be detected by measuring the amount of gonadotropin
hormone in the blood.
What is the treatment?
If a doctor diagnoses cyptorchidism in a patient over
three years of age, treatment will usually follow. If left
untreated, an undescended testicle can lead to sterility
and an increased risk of testicular cancer. The doctor may
recommend hormonal injections to help the testicles
descend. The success of treatment depends on the position
of the testicles at diagnosis.
If hormone therapy is not successful, the doctor may
perform a surgery called orchiopexy through a small
cut in the groin. Recent improvements in surgical
technique, including laparoscopic approaches to diagnosis
and treatment, may improve the outcome. While orchiopexy
may not protect patients from developing testicular
cancer, the procedure allows for earlier detection through
self-examination of the testicles. The doctor may also prescribe the
hormone called hCG, which will help the testicles make
male hormones. A higher level of male hormones might move
the testicle down into the scrotum. In adults with an
undescended testicle, moving the testicle to the scrotum
probably won't improve the ability to make sperm, so the
undescended testicle is usually just taken out. Doctors
will often not treat an undescended testicle in men over
40.
Self-care tips
Since a man's ability to make sperm can be lost in
early childhood if the testicle doesn't drop down into the
scrotum, receiving treatment for cyptorchidism in the
first few years of life can increase his chances of having
children later on. Additionally, undescended testes are
twice as likely to develop cancer. Ten percent of all
testicular cancers are in undescended testes.
The patient should be aware if undergoing surgery for
cryptorchidism, injury to the testicular blood vessels or
vas deferens (the tube that carries sperm) might occur
when performing an orchidopexy. These structures are
delicate and require the doctor be precise while
performing the surgery. Rarely, there are some testicles
that don't reach the scrotum after the first surgery and
require a second surgery (about a year later) to bring
them into their normal scrotal position.
This information has been designed as a comprehensive and quick reference
guide written by our health care reviewers. The health information written
by our authors is intended to be a supplement to the care provided by your
physician. It is not intended nor implied to be a substitute for
professional medical advice.
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