Undescended Testicles (Cryptorchidism)

What is an undescended testicle?

An undescended testicle is one that fails to move into the scrotal sac (external skin pouch located behind the penis) from within the abdominal cavity, where it is positioned in the foetus.

Normally, the two testicles descend into the scrotum before birth. However, in about 1% of all male infants, and in 10% of premature baby boys, this development has not occurred by the time of birth. One or both sides of the scrotum are empty, indicating either that the testicles have not descended to their appropriate place, or are missing entirely. If both testicles are present, but not in their proper place, the baby is said to have undescended testicles. This condition, known as cryptorchidism, can affect either, or both, testicles in a particular individual, although normally only one testicle is affected.

Symptoms

  • The scrotum is flat and empty on one or both sides of its midpoint.
  • Gentle touching or pushing with a finger high up on the scrotum does not detect the presence of the egg-shaped testicle.

Are there different types of undescended testicle?

There is no agreement amongst developmental biologists as to the cause of the disorder. An unde­scended testicle may result from a shortened spermatic cord (structure from which the testicle is suspended in the scrotum); or a blockage on the testicle's route to the scrotum. Even so, not all testicles that are absent from the scrotum are classified as being undes­cended.

The following variations in type are generally recognized:

Ectopic testicle:

This is a misplaced testicle which has developed normally, but has been diverted to

the wrong location as it descends the inguinal canal (passage connecting the abdominal cavity with the scrotum in the developing male foetus). The commonest of such abnor­mal locations are the groin and the root of the penis.

When this misplace­ment occurs, a tube called the epididymis (sperm conduit), which is attached to the testicle, is also misdirected in its descent. One theory holds that the downward move­ment of both testicle and epididymis is directed by a tissue structure called the gubernaculum. This structure swells in the inguinal canal, under the influence of the male sex

hormone testosterone, creating space for the testi­cle to follow it into the scrotum. When something goes amiss in this process, the testicle becomes wrongly located.

  • Cryptorchidism: This refers to a testicle which remains inside the abdomen. It is regarded as the 'true' condition of unde­scended testicle. The term derives from the Greek crypto, meaning hidden. This is a more serious condition, as the testicle is likely to be poorly developed. Unlike an ectopic one, such a testicle will never produce adequate amounts of viable sperm and may have a restricted blood supply.
  • Retractile testicle: In this case, the testicle may be felt in the scrotal sac, although it is liable to sporadically retract up into the abdomen in response to cold or touch.
  • Noonans syndrome: This is one of several inherited defects, in which the child's body does not produce adequate male sex hormones. When both testicles are undescended, such a cause will often be suspected and appropriate investigations made.

How is the condition diagnosed and treated?

The empty scrotal sac will be apparent upon examination. Some doctors may examine the baby in a warm bath, in order to rule out retractile testicles. The

warmth relaxes the cremaster muscle (muscle that lines the scrotum), which sometimes tightens in response to a stimulus such as cold, thrusting the testicle upwards into the inguinal canal or the abdomen. This condition is usually harmless since the testicles eventually descend permanently, and the sperm they produce will be normal.

If the cremasteric reflex is not the problem, the doctor will try to locate the missing testicle.

In the case of unde­scended testicle, over half the affected testicles will descend without treatment within a month, and a total of about 80% will descend within the first year. The decision must be made whether to wait and see what will happen, or to operate to reposition the testicle. Surgery is usually recommended.

When a testicle remains undescended, the situation is more complicated and genetic tests may be ordered. The testicle can be moved down to the scrotum surgically, but may not produce sperm. It will be abnormally vulnerable to testicular cancer, so some experts recommend that such testicles be surgically removed if they do not produce sperm. These males may need injections of male hormones as they reach the age of puberty.

The outlook for a boy with cryptorchidism is

less clear-cut than that for a child with ectopic testicles. He may or may not develop normally, and continuing care from a pediatric urologist (specialist in conditions of the urinary tract in children) will probably be needed.

When should I see my doctor?

If one or both sides of the baby's scrotum appears empty, part or all of the time, consult your doctor.

What will the doctor do?

Your doctor will examine the baby, and is likely to refer you to a paediatri­cian, or to a specialist in paediatric urology.

Is an undescended testicle serious?

The retractile and ectopic forms of this disorder are not likely to be dangerous. However, true crypt­orchidism may indicate potential problems in that the abnormal testicle is more susceptible to developing cancer.

For the child's psycho­logical well-being, which may be significantly threatened, it is advisable to deal with problems relating to the testicles as early in life as possible.

WARNING

Do not, under any circumstance, attempt to re-position a young baby's testicles.

tony
 

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