Contents
Definition: what is testicular cryptorchidism?
It’s a barbaric name that can be scary, yet it designates a fairly common phenomenon that is good to know as a young parent, not to panic when hearing it.
A little etymology first. The word “cryptorchidism” comes from the Greek “kryptos“, Which means” hidden “, and”orkhis“, Which means“ testicle ”. Cryptorchidism means stopping the migration of the testis on its normal course between the lumbar region (where it forms) and the scrotum (commonly called the bursa) where it should be at birth. When both testicles are involved, we speak of bilateral cryptorchidism, as opposed to unilateral cryptorchidism when one of the two testicles has reached the purses.
Note that it is common for cryptorchidism to be associated with inguinal hernia, which corresponds to the passage of abdominal viscera (most often small intestine) in the peritoneo-vaginal canal which has persisted. Again due to a “defect” at the time of testicular migration.
A frequent pathology, whether bilateral or not
Cryptorchidism is a frequent condition, for which there is no geographic or ethnic predominance.
It is estimated that 1 to 4% of term newborns are affected. Cryptorchidism is even more common in premature babies, since 20 to 30% of them are affected.
Time can sometimes be sufficient to correct this abnormality of the male reproductive system, since the frequency of cryptorchidism drops to 1% by the age of six months.
In 80% of cases, only one testicle did not descend. In the remaining 20% of cases, cryptorchidism is bilateral and therefore concerns both testes.
Cryptorchidism or ectopic testis: what’s the difference?
In medical jargon, we differentiate between cryptorchidism, when the testis has not descended but is on the normal course of migration, from testicular ectopy, when the undescended testicle is located outside the normal course of testicular migration.
In the case of testicular ectopy, the testicle may be located:
- in the pre-penile area, in the middle of the abdomen, between navel and penis;
- in the femoral area, at the junction between leg and abdomen;
- in the perineal area, between anus and penis;
- or in the retroperitoneal zone, towards the navel (the peritoneum designating the envelope in which the digestive organs are located).
Cryptorchidism and testicular ectopia: what causes?
During fetal life, in the “boy” fetus (XY), the testes are first present in the abdomen, and then gradually migrate to the bursa, from the third month of pregnancy. When a migration defect occurs, it happens that a testicle does not reach its destination. We speak of an undescended testicle when the testicle is absent from the bursa.
The hypotheses put forward to explain the appearance of cryptorchidism or testicular ectopia are numerous. It could be :
- the presence of an obstacle to the migration of the testis (narrow inguinal canal, too short spermatic vessels and nerves, fibrous obstruction of the scrotal orifice, abnormal adhesion of the fetal testis to the retroperitoneal tissue);
- an anatomical abnormality;
- a hormonal problem during pregnancy (insufficient production of male hormones, or androgens, and / or too much exposure to female hormones, or estrogen, etc.
It exists several risk factors identified :
- prematurity;
- low birth weight;
- a breech birth;
- a familial predisposition (urogenital malformations in the father or in the siblings, whether it is cryptorchidism, hypospadias, micropenis or other);
- exposure to endocrine disruptors during pregnancy (via food, pesticide residues, hygiene and cosmetic products, at work, etc.).
Cryptorchidism: when and how is the diagnosis made?
The diagnosis is usually made at birth or during the first medical visits of the newborn, by the pediatrician or general practitioner who follows the child.
Parents themselves may find that one bursa looks more “empty” than the other, or even identify a lump in their infant’s groin, if the undescended testicle is there.
In the absence of a testicle in the scrotum at birth, a s will be necessary. The healthcare professional will regularly examine the bursae of an infant with an undescended testicle, during the first 6 months of life, to see if the testicle descends or not.
For the palpation to go well, it is better for the child to be calm and confident, lying on his back, with the thighs slightly bent. You can sit cross-legged from the age of 6 months, for more comfort.
If the undescended testicle is palpable, the doctor will examine its size and consistency. If it is not palpable, it is because it is either abdominal or atrophic; a Abdominal ultrasound may be prescribed to locate it. Laparoscopy often makes it possible to find a testicle located intra-abdominally.
Additional examinations may also be undertaken, such as blood tests (testosterone dosage, karyotype, etc.), in particular if no testis has arrived in the scrotum.
What treatment for an undescended testicle?
When to consider surgery
In the case of cryptorchidism, sometimes the testicle descends into the scrotum during the child’s first year of life. Also, no therapy is generally implemented before the age of 18 months. The standard treatment, which is surgical, will be undertaken during the child’s second year.
The course of an orchidopexy
Called orchidopexie the surgical operation which consists in fixing the undescended testicle inside the scrotum.
Like any surgical intervention, this requires a preliminary pre-anesthetic consultation with an anesthesiologist. Most of the time, this surgery takes place under general anesthesia, and on an outpatient basis, that is to say with a return home during the day.
Specifically, surgical treatment involves releasing the spermatic cord that holds the testicle in a high or lateral position. Two small incisions are made, one in the groin, the other on the upper part of the purse. In 90% of cases, the surgery is performed in one step when the length of the spermatic cord allows it. But if the cord is too short, a second intervention may be necessary.
If the undescended testicle is in the abdominal position, an exploration by laparoscopy is often undertaken before surgery, to highlight the testicle and assess its condition (atrophied or not). In a second step, one proceeds to an orchidopexy.
During surgery, the urologist will check the size and consistency of the testicle to be placed in the bursa. Because if he considers it really abnormal, he can choose not to replace it (we are talking aboutorchidectomies), and to suggest to the patient to replace it, at puberty, by a testicular prosthesis, for aesthetic reasons.
Monitoring after the operation
The operative consequences of an orchidopexy are quite simple. After the operation, it will be good heal scars (care and dressings),avoid swimming pool baths and cycling for a fortnight. In the event of pain, traditional analgesics can be prescribed (paracetamol).
A hematoma can appear on the bursa, but should not be worried.
In case of fever, sharp pain or abnormal swelling in the bursa, it is good to see a doctor to check that it is not an infection.
At a distance from the intervention, palpation of the testicle can be considered regularly for check if the testicle is still in place, and if it looks the same to the touch as the other testicle. A manipulation that the child can obviously carry out himself, why not after a doctor has taught him the technique of palpation. Note that every man should regularly practice the self-examination of the bursaries to check that all is well, as we recommend the self-examination of the breasts to women against breast cancer.
Male infertility, cancer: complications in the absence of care
As it is not in its “normal” place, an undescended testicle can cause several more or less serious complications, which is why it is good to operate if the testicle does not end up descending after a few months.
Among possible complications, let us quote in particular:
- infertility, due to an inadequate temperature for sperm production (see box below);
- testicular cancer, a rare pathology but the leading cause of cancer in men aged 20 to 35;
- a torsion of the testicle, which alters its good vascularization and requires urgent care;
- trauma to the testicle, especially if it is in the groin or groin;
- aesthetic discomfort and ultimately psychic discomfort, even though the absence of a testicle or a badly formed testicle can be compensated for by a testicular prosthesis.
Why can cryptorchidism cause infertility?
To make viable sperm, the testes must be at a lower body temperature (37 ° C). This is also why they migrate into the scrotum, outside the body, where the temperature fluctuates between 33 to 35 ° C.
If the testicle remains in the abdomen, in the peritoneal area, or in the groin, it remains at 37 ° C. Spermatogenesis is then imperfect, which can lead to infertility or even sterility.
On its site, the Health Insurance specifies that the risk of infertility is 5% in the case of unilateral cryptorchidism, but that it can reach 50% if it is bilateral. If it reduces the risk of infertility by half, surgical treatment should be started early.