Edit concept Question Editor Create issue ticket

Cryptorchidism

Undescended Testis

Cryptorchidism is characterized by absence of one or both testes from the scrotum. This is one of the more common types of birth defects seen in male infants.


Presentation

The major and only sign of undescended testicles, is not feeling them in the scrotum. Studies have postulated the fact that, male boys with crytorchidism often suffer from psychological symptoms. It was seen that, when these boys underwent surgical procedures to correct the condition, a sudden boost in masculine characters and confidence occurred.

Epilepsy
  • He presented with facial anomalies, mental retardation, epilepsy, hypotonia, and agenesis of the corpus callosum.[ncbi.nlm.nih.gov]
  • Parental infertility, fertility treatment, and childhood epilepsy: a population-based cohort study. Paediatr Perinat Epidemiol. 2016;30(5):488–495. 39. Henriksen TB, Baird DD, Olsen J, Hedegaard M, Secher NJ, Wilcox AJ.[dovepress.com]
Pediatric Disorder
  • PURPOSE: Cryptorchidism is one of the most common pediatric disorders of the male endocrine glands and the most common genital disorder identified at birth.[ncbi.nlm.nih.gov]
Inguinal Mass
  • A 2-year-old cryptorchid boy with an inguinal mass was found to have a MCSC which was confused with undescended testis. The testis was readily placed into the hemiscrotum after excision of the cyst.[ncbi.nlm.nih.gov]
Male Hypogonadism
  • Male hypogonadism: an extended classification based on a developmental, endocrine physiology-based approach. Andrology. 2013; 1:3-16. 18. Brioude F, Bouligand J, Trabado S et al.[revistas.uis.edu.co]
Inguinal Mass
  • A 2-year-old cryptorchid boy with an inguinal mass was found to have a MCSC which was confused with undescended testis. The testis was readily placed into the hemiscrotum after excision of the cyst.[ncbi.nlm.nih.gov]
Recurrent Abdominal Pain
  • A 5-year-old boy who had recently moved to the United Kingdom presented at the endocrinology clinic with recurrent abdominal pain.[ncbi.nlm.nih.gov]
Loss of Appetite
  • A 32-year-old man presented with a three-month history of dyspnea, loss of appetite, general weakness and a large abdominal mass. Physical examination revealed vacancy of the right scrotal contents.[ncbi.nlm.nih.gov]
Joint Stiffness
  • Characteristics include red or dark patches on the skin; burning, itching, swelling, hardening, and tightening of the skin; yellow spots on the whites of the eyes; joint stiffness with trouble moving or straightening the arms, hands, legs, or feet; pain[emedicine.com]
Normal Stature
  • This report reemphasises the previously reported traits of craniofacial dysostosis syndrome and suggests that cryptorchidism represents part of the syndrome profile and that the presence of normal stature does not preclude the diagnosis.[ncbi.nlm.nih.gov]
Anorchia
  • Approximately 70% of cryptorchid testes are palpable within the upper portion of the scrotum or inguinal canal, whereas the other 30% are not palpable, suggesting either an intra-abdominal location, testicular nubbin, or anorchia.[bestpractice.bmj.com]
  • Cf Anorchia. cryp·tor·chism ( kript-ōr'kizm ) Failure of one or both testes to descend. Synonym(s): cryptorchidism. cryptorchidism Cryptorchism, undescended testicle.[medical-dictionary.thefreedictionary.com]
  • Absence of both testes (anorchia) is rare.[bettersafercare.vic.gov.au]
  • […] inguinal hernia Terminology Cryptorchidism : absence of one or both testes in the scrotum most commonly due to failure of descent into the scrotum during fetal development May occur with gonadal dysgenesis or following testicular ascent later in life Anorchia[pathologyoutlines.com]
  • With a normal phenotype and normal 46-XY karyotype, the diagnosis anorchia can be regarded as certain (modified from [9]).[ncbi.nlm.nih.gov]
Testicular Disease
  • Cryptorchidism can therefore be considered a symptom of impaired testicular function that may also be linked to other testicular diseases, such as germ cell cancer and subfertility.[ncbi.nlm.nih.gov]
  • Cromie WJ: Cryptorchidism and malignant testicular disease, in Hadziselimovic F (ed): Cryptorchidism: Management and Implications. New Yeok, Springer-Verlag, 1983; 83. 228.[auanet.org]

Workup

The following methods are carried out to diagnose the condition of cyrptorchidism [7]:

  • Laparoscopy: This kind of procedure is done to locate intraabdominal testicles. In many cases, it would be possible to fix undescended testicles. However, additional procedures to correct the condition may also be required.
  • Imaging studies: Imaging studies such as CT scan and MRI may also be done, but these procedures are not cost effective. Examination of the condition by a pediatric urologist has been found to be more accurate than other studies. In cases, when intersexuality is suspected, then ultrasonography along with genitography should be done.
Left Pleural Effusion
  • Chest radiograph showed massive left pleural effusion. Abdominal ultrasound revealed ascites, right hydronephrosis and the presence of an 18 x 15-cm heterogeneous echogenic mass in the upper abdomen and right iliac fossa.[ncbi.nlm.nih.gov]
Polyps
  • The coexistence of polyp of the verumontanum, epidermoid paraurethral cyst and cryptorchidism presents a mosaic of congenital anomalies of the urogenital tract.[ncbi.nlm.nih.gov]

Treatment

Early initiation of treatment would help in preventing complications. If treatment is given during the first year of life, then there are less chances of onset of complications later. The following methods are employed for treating cryptorchidism:

  • Surgery: This is often the method of choice for correcting the condition of cryptorchidism. Such a type of procedure is done either through laparoscopy or through open surgery [8].
  • Hormone therapy: In this method, the boy is given human chorionic gonatropin injections. This could cause the testes to move to the scrotum. Such a kind of procedure is however a less effective method in comparison to surgery [9] [10].
  • Prostheses: This is usually the last resort and adhered to when hormone therapy and surgery cannot be used because either one or both the testicles are missing or have got damaged during surgical procedure. In such cases, saline testicular prostheses are implanted. This is done during late childhood or in adolescence stage. Such a kind of procedure gives the scrotum a normal look.

Prognosis

In majority of the cases, the testes descend within the first few months of life. In cases, when they fail to do so, surgical procedures may have to be adopted. Surgery and medications employed to treat the condition is successful in most of the cases. However, in about 5% individuals, it is difficult to find testicles at the time of surgery. Such a type of condition is known as absent testis [6].

Etiology

The exact cause of cyrptochidism is not clearly known. However, interplay of genetic and hormonal factors along with maternal health are known to influence the development of undescended testes. Research has also shown that changes in the activity of the nerves and various environmental factors are also known to play foul [2]. In addition, several risk factors are also known to increase the likelihood of developing cryptorchidism. These include [3]:

Epidemiology

It has been estimated that, 30% of preterm infants develop undescended testes. The incidence of such a type of condition is found in only 3% of full term infants. The incidence of cryptorchidism decreases to 1% within 6 months to 1 year. The prevalence rate of cryptorchidism in the US is estimated to be 3.7% at birth and 1.1% from 1 year to adulthood.

Sex distribution
Age distribution

Pathophysiology

Under normal conditions, the development of the testicles begins during conception. The SRY gene is the testes determining factor which if present favors the normal development of testes. At 3 to 5 weeks of gestation period, development of gonadal ridge occurs, which is followed by development of Sertoli cells. At 9 weeks gestation, the Leydig cells develop which secrete testosterone. Ultrasonography done before 28 weeks of gestation does not provide any evidence of testicular descent. The tests only provide knowledge about transabdominal movement to the internal side of inguinal ring [4].

During the last few months of fetal development, the testicles descend from tube like structure which is known as the inguinal canal into the scrotum. In condition of cryptorchidism, this process does not occur or is delayed [5].

Prevention

It is not possible to prevent the development of cryptorchidism as formation of testicles begins during conception. Moreover, the exact cause of the condition is not known. However, certain risk factors can increase the risk of developing the same and in this regard; mothers are advised to avoid smoking and alcohol consumption during fetal development. They are also advised to stay away from second hand smoke and restrict themselves from exposure to environmental toxins and pesticides.

Summary

Cryptorchidism is more prevalent amongst infants who are born preterm. Full term infants are less likely to suffer from the same. By the time infants turn 9 months, the boy’s testicles descend naturally. In majority of the cases, only one testis is affected; however in 10% of cases, both testes fail to descend. Many a time undescended testis corrects by itself within the first few months of life. In cases, when this does not happen naturally, corrective surgical procedures may be required [1].

Patient Information

Definition: Cryptorchidism is a condition, wherein the testes do not descend naturally after birth of the child. It is a common birth defect which often gets naturally corrected by the time the child is 1 year old. The condition is a common phenomenon amongst preterm infants. Full term babies are very rarely affected by this condition.

Cause: The exact cause of cryptorchidism is unknown. However, several risk factors can increase the chances of developing the same. These include maternal exposure to environmental toxins, pesticides, second hand smoke and underlying disease conditions such as Down syndrome. Mothers who smoke or drink alcohol or have diabetes also put their babies at risk of developing undescended testes.

Symptoms: The major symptom of cryptorchidism is not feeling any testicle in its original position. Boys who experience this are also known to suffer from psychological symptoms.

Diagnosis: The condition is best diagnosed by a pediatric urologist. Several methods such as ultrasonography and imaging studies can also be performed to study the condition. However, none of these methods are cost effective. The method of laparoscopy is carried out detect the intrabdominal testicle.

Treatment: Surgery and medications forms the basis of treatment regime. Surgery to put the testes back into position is done either through open surgery or through laparoscopy. Hormone therapy is done by injecting human chorionic gonadotropin, which would cause the testicles to move to the scrotum. Prostheses may be implanted when either or both the testes are missing or they have been damaged during surgery.

References

Article

  1. Docimo SG. Testicular descent and ascent in the first year of life. Urology 1996; 48:458.
  2. Elert A, Jahn K, Heidenreich A, et al. [The familial undescended testis]. Klin Padiatr. Jan-Feb 2003;215(1):40-5.
  3. Schiffer KA, Kogan SJ, Reda EF, Levitt SB. Acquired undescended testes. Am J Dis Child 1987; 141:106.
  4. Yamanaka J, Baker M, Metcalfe S, et al. Serum levels of Mullerian inhibiting substance in boys with cryptorchidism. J Pediatr Surg. May 1991;26(5):621-3.
  5. Hadziselimovic F, Herzog B, Buser M. Development of cryptorchid testes. Eur J Pediatr 1987; 146 Suppl 2:S8.
  6. Pirgon Ö, Dündar BN. Vanishing testes: a literature review. J Clin Res Pediatr Endocrinol 2012; 4:116.
  7. Penson DF, Krishnaswami S, Jules A, et al. Evaluation and treatment of cryptorchidism. Comparative Effectiveness Review No. 88. AHRQ December 2012. 
  8. Docimo SG. The results of surgical therapy for cryptorchidism: a literature review and analysis. J Urol. Sep 1995;154(3):1148-52.
  9. Hadziselimovic F, Girard J, Herzog B, et al. Hormonal treatment of cryptorchidism. Horm Res. 1982;16(3):188-92.
  10. Ludwikowski B, González R. The controversy regarding the need for hormonal treatment in boys with unilateral cryptorchidism goes on: a review of the literature. Eur J Pediatr 2013; 172:5.

Ask Question

5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.
By publishing this question you agree to the TOS and Privacy policy.
• Use a precise title for your question.
• Ask a specific question and provide age, sex, symptoms, type and duration of treatment.
• Respect your own and other people's privacy, never post full names or contact information.
• Inappropriate questions will be deleted.
• In urgent cases contact a physician, visit a hospital or call an emergency service!
Last updated: 2019-06-28 12:29