Cryptorchidism or undescended testicle at a glance
- Cryptorchidism, also known as undescended testicle, is a common male birth defect in which one or both testicles have failed to drop into the scrotum.
- About 1-4.5 percent of male infants will have an undescended testicle, according to the National Institutes of Health, affecting 30-45 percent of preterm boys.
- Undescended testicle is usually diagnosed at birth and monitored in the following months.
- Often, the condition will self-correct as the infant matures, but treatment is advised for an undescended testicle that does not resolve on its own.
- Hormonal therapy and surgical correction are the two forms of treatment, with surgical treatments used most often.
- Corrective surgery will lower certain risk factors and aid in preventing complications that may otherwise result.
What is cryptorchidism (undescended testicle)?
Undescended testicle, or cryptorchidism, is a common congenital defect in which a child is born with one or two testicles that have yet to descend into the scrotum. This condition affects 1-4.5 percent of male infants, with a much higher incidence in boys born prematurely (30-45 percent). Most often, just one testicle is affected, but in about 10 percent of diagnosed cases, both testicles are found to be undescended.
In normal male anatomy, testicles are housed within the scrotum. This pouch-like portion of the male genitals hangs just below the penis and is generally several degrees cooler in temperature than the human body. This is an ideal environment for sperm production once the male reaches sexual maturity.
Male genitalia begin developing early in pregnancy, with the first distinguishing sex characteristics appearing approximately 11 weeks after conception. Up until the third trimester however, the testicles are lodged within the abdomen of the fetus. In most cases, the testicles will drop into the scrotum sometime during this final trimester.
Sometimes the undescended testicle will naturally move into place during the early months of an infant’s life. If this does not happen, the urologist will recommend correction by hormone therapy or surgery, which is most often used.
If an undescended testicle does not self-correct and is left untreated, the child faces increased risks of:
- Testicular cancer
- Testicular torsion (twisting of the spermatic cord)
- Psychological and emotional distress.
Causes of undescended testicle
The specific cause of undescended testicle is not well understood, but certain factors that inhibit, restrict or otherwise negatively affect fetal development may increase the risk of the defect. These factors include:
- Tobacco and/or alcohol use by the mother during pregnancy
- Family history of genital development issues
- Concurrent congenital defects such as Down syndrome
- Low birth weight
- Parental exposure to certain chemicals or pesticides.
Symptoms and diagnosis of undescended testicle
Most often, an undescended testicle is identified during a routine physical examination shortly after birth. At this time, the doctor will attempt to locate the undescended testicle(s) in order to determine the best course of action. In some cases, a test such as a magnetic resonance imaging (MRI) or ultrasound scan may be performed. Typically, the only external symptom of an undescended testicle is its absence in the scrotum. The condition is normally painless.
A physician’s diagnosis will also help to differentiate undescended testicle from another common condition called retractile testicle. Retractile testicle is a generally benign issue in which one or both testicles move freely between the abdomen and scrotum. A retractile testicle will usually cease retracting after puberty, but the doctor may elect to monitor the condition as the child matures.
Treatment of cryptorchidism (undescended testicle)
An undescended testicle identified at birth will often fall into place on its own as the infant grows and develops. If it does not, several treatment options are available.
Hormone therapy to treat cryptorchidism most commonly involves a series of injections of HCG (human chorionic gonadotropin). This is a naturally occurring hormone produced by women during pregnancy that aids in the development and release of an egg at ovulation.
Introducing this hormone to the child may provide the developmental stimulation necessary to cause the undescended testicle to drop into the scrotum on its own. Other hormones used to treat cryptorchidism include testosterone, gonadotropin-releasing hormone (GnRH), luteinizing hormone (LH) and human menopausal gonadotropin (hMG).
Hormone therapy for cryptorchidism is not nearly as effective as surgical treatment. But it may be an appropriate option for some patients, especially those who are not candidates for surgery or who are suspected of having retractile testicle.
The surgical treatment of undescended testicle is called orchiopexy. Orchiopexy is a minimally invasive laparoscopic surgery performed by a trained urologist. This procedure brings the testicle into the scrotum and secures it there in the space created.
Orchiopexy is usually an outpatient procedure involving general anesthesia, which means the child will be asleep during the operation. The laparoscopic technique used in orchiopexy allows Urology Associates surgeons to use incisions that are less than half an inch in length, while significantly decreasing the risks and side effects present in traditional surgical methods.
Risks and recovery from cryptorchidism treatment
In the first two weeks following the surgery, boys will need to avoid high-energy activities that may put the genitals at risk of injury. This will ensure that the area heals properly. Typically, the physician will schedule a follow-up appointment 2-3 months after the surgery.
As with all surgeries, some risks such as tissue damage, infection, pain, adverse reaction to anesthesia, and scarring are possible. These risks are significantly lower in minimally invasive orchiopexy than in traditional surgeries.
Children born with an undescended testicle do carry a slightly higher risk of infertility even after treatment, with significantly higher risks in cases in which the child was born with both testicles undescended. Additionally, children with cryptorchidism are slightly more prone to develop testicular cancer. This factor reinforces the need for corrective treatment, as cancer is much easier to detect once a testicle has properly descended into the scrotum.