Cryptorchidism – types, causes, diagnosis, treatment

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Cryptorchidism is a developmental defect in newborns where the testicle is misplaced, such as in the groin or abdomen. The causes of cryptorchidism lie in genetics and endocrinology, but the disorder can also result from mechanical trauma.

Cryptorchidism – the definition of the disease

Cryptorchidism is a developmental defect in newborns characterized by an abnormal positioning of the testicle, such as in the abdomen or groin. This ailment occurs in humans, but also in mammals. Cryptorchidism is the most common developmental defect in boys. About 3,4% of male neonates have one or both testicles missing from the scrotum. While still in the fetal stage, the boy’s testicles descend from the abdominal cavity into the scrotum, but very often this does not happen until after birth – which is also perfectly normal.

The ailment of cryptorchidism is most common in premature babies with low birth weight. Cryptorchidism can be caused by genetics, endocrine problems, or mechanical trauma. Moreover, at the age of 4-5 years, the intensively developing testicular levator can cause “acquired” cryptorchidism.

Cryptorchidism – causes

Cryptorchidism, i.e. the failure of the testicles, is preceded by a hormonal imbalance in the mother during pregnancy, an abnormal structure of the testicle or mechanical trauma. Descending testes may occur in the abdominal cavity, in the inguinal canal, and in the pre-scrotum.

Types of cryptorchidism

Cryptorchidism is divided into several forms, depending on the position of the testicle.

1. Cryptorchidism – the gonad is arrested in the correct descent path between the inner and outer rings of the inguinal canal. During the examination, the doctor feels the testicle but is unable to move it into the scrotum.

2. Abdominal cryptorchidism – during the examination, the doctor does not feel the testicle, but sometimes during the tension of the abdominal pressure it is felt next to the inner ring of the inguinal canal. The abdominal testis can be diagnosed on the basis of computed tomography, ultrasound or laparoscopy.

3. Wandering cryptorchidism – the gonad may be in the scrotum, but has a predisposition to regress into the inguinal canal.

4. Cryptorchidism displaced – the nucleus avoids the correct path during descent. It can move to the suprapubic space, thigh, crotch, recess surface of the inguinal canal. The kernel is usually well-structured and of an appropriate size.

The above-mentioned division is considered to be imprecise because large discrepancies are observed when comparing the correct clinical examination with the operational observations. High controversy in this matter and uncertainty as to the method of diagnosis and treatment are caused by testicles that are not palpable during the examination, as well as migrating testicles.

Cryptorchidism – diagnosis

Contrary to appearances, the diagnosis of cryptorchidism is not the easiest task, because we often deal with wandering nuclei. Parents can carry out the test themselves at home, at an appropriate temperature. It is best to do this after bathing (the temperature must not change significantly as lowering it may give a false test result) when the baby is completely calm and relaxed. If you feel your little one has no testicle or its unusual position – contact a pediatrician immediately.

In the diagnosis of cryptorchidism, many diagnostic tests are carried out to determine the presence or absence of a testicle. Such studies include, among others:

1. computed tomography,
2. Ultrasound,
3. laparoscopic examination,
4. venography.

Additionally, hormonal tests are performed (in the case of confirmation or exclusion of hereditary lack of testicles). Congenital absence of testicles is confirmed by increased gonadotropin levels and a lack of testosterone response to hCG stimulation. The diagnosis of cryptorchidism is largely based on clinical trials.

Cryptorchidism – treatment

Treatment of cryptorchidism may be conservative or operative. Conservative treatment is due to one of the main causes of cryptorchidism – fetal hormonal dysfunction. The indication for conservative treatment is the presence of canal cryptorchidism, while the contraindication is the abdominal testicle or a displaced testicle with an inguinal hernia.

If the testicles are not in the scrotum of a 3-4-year-old boy, a urologist should be consulted. In the event of bilateral cryptorchidism, the initial treatment should be the administration of human chorionic gonadotrophin. Hormones are given to the child in several doses, depending on his age and weight. Hormone therapy usually takes several weeks. If hormonal treatment under the supervision of a urologist does not bring the expected result in the form of the descent of the testicles into the scrotum, surgery should be started.

Patients with the abdominal, canal and displaced testes as well as those accompanied by an inguinal hernia may be qualified for surgery. Surgical treatment consists in lengthening the seminal cord, bringing the testicle to the scrotum and fixing it. Treatment of cryptorchidism should be completed before the age of 6. Undescended testes are 40 times more likely than normal testes to undergo neoplastic changes.

The optimal age for cryptorchidism is 2-3 years. year of life. However, many doctors believe that orchidopexy should be performed before a child is two years old.

Adequate treatment may not only improve fertility, but also increase the psychological comfort of the boy / man. The lack of one testicle in the scrotum often causes a mental breakdown and many complexes. In addition, an undescended testicle carries a risk of developing cancer.

Cryptorchidism and complications

The most important and the most serious complication of cryptorchidism is infertility. Primary hypoplasia of the gonad can cause changes that in turn lead to disorders of the seminal tubules. The changes may also result from poor function of the hypothalamic-pituitary-testes axis or be the result of exposing the testes to high temperatures. All these elements lead to disorders of normal spermiogenesis, which in the future causes a significantly reduced male fertility.

There is also much talk about a tumor that can develop in an undescended nucleus. About 10% of all testicular tumors are in the undescended testes, the most common are tumors in the abdominal testes. This may suggest a relationship between the neoplasm and the degree of dysgenetic changes in the undescended nucleus. In undescended testes, about 60% of tumors are seminomas that develop from abnormal forms of terminal epithelium. Much less often germ cell tumors or teratomas are diagnosed.

Testicular cancer usually attacks men over 30 years of age – operated on for cryptorchidism, as well as in the remaining ones. Most often, the changes are observed in the testicles, which are reduced to the scrotum, as well as in the opposite testes located in the scrotum.

The risk of malignant cryptorchidism, especially for migrating, groin or dislocated testes is low. The testes located abdominally are a greater threat, especially if they are accompanied by other sexual disorders.

Read also: Examine your testicles in front of the mirror

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