IASH India: Institute of Andrology & Sexual Health India
Cryptorchidism: Symptoms, Causes, and Treatment

What is Cryptorchidism?

Cryptorchidism or undescended testicle (or “testis”) occurs whenever the testicle does not descend to its original location in the scrotum. Your child’s doctor may detect it during a normal examination. Approximately 3 to 4 of every 100 babies are affected and out of 100 premature newborns have this condition. Fortunately, around half of such testicles will fall off within the first three months of life. However, testicles do not descend naturally beyond 3 months. Consequently, around 1 or 2 of 100 males with undescended testes will require therapy. It is essential to distinguish undescended testicles from retractile testicles. 

After 6 months of age, a male infant develops a protective reaction that momentarily raises the testicles whenever he is cold or scared. These testicles are normally located in the scrotum and do not need therapy. However, only undescended testicles require treatment.

A pediatric urologist can distinguish between the two by physical examination. To produce sperm, the testicles must be 2 to 3 degrees lower than the usual body temperature. Testicles that fail to descend into the scrotum will not function correctly. The greater the testicles remain overheated, the less likely the sperm will develop appropriately. So this may lead to infertility, particularly if both testicles are damaged. Further, cryptorchidism also links to:

  • Developing testicular cancer upon growing up
  • Testicular torsion Development of hernia near the groin

What Occurs Under Regular Conditions?

Two organs that hang beneath the penis in a pouch-like membranous sac are the testicles (or “testes”) (the scrotum). Sperm and testosterone get produced in the testicles. The scrotum maintains a milder environment for the testicles than the body because sperm cannot develop at body temperature. 

During development, sperm in the testicles undergo a process that leads to the development of mature sperm around puberty. Normal testicles develop early in a boy’s development. After pregnancy, they drop into the scrotum after forming in the lower abdomen. Normal testicles adhere to the scrotum’s bottom through stretchy tissue. The regular hormones of the infant govern this. 

Cryptorchidism Causes

In most children with cryptorchidism, it is unknown why the testicles fail to fall. It could be that the testicles are abnormal, to begin with. In other instances, a mechanical issue exists. The testicles fall but escape the scrotum, landing beside it rather. So these are referred to as ectopic testicles. Or the child’s hormones may be unable to activate the testicles properly. 

Further, no research has demonstrated that the issue results from whatever the mother did or ended up eating during pregnancy. Occasionally, the testicles fall but do not connect to the scrotum. Then, as the male child develops, it becomes evident that his testicles are not connected. Approximately 1 in 5 incidences of undescended testicles is in boys who are no longer infants. For this reason, the position of every boy’s testicles needs thorough examination during their yearly medical examination.

Cryptorchidism Diagnosis

An ultrasound scan may frequently reveal the position of the impalpable testicle.  A doctor, on the other hand, typically considers this measure to be unnecessary. A specialist known as a pediatric urologist may seek further tests in specific circumstances.

The following tests may be performed:

  • Laparoscopy: A laparoscopy procedure in which a doctor introduces a thin tube with a lens into the belly via tiny incisions. Additionally, they may also use the same instrument to do corrective surgery if required.
  • Open surgery: Surgeons will utilize this to openly probe the stomach in rare, complex circumstances.

If the doctor cannot discover any testicles in the scrotum after delivery, he or she may request further tests to establish if the testicles are undescended or not. If left undetected and untreated, several diseases that result in nonexistent testicles might cause major medical complications shortly after birth.

Cryptorchidism or Undescended Testicles Symptoms

Undescended Testicles could be unpalpable or palpable.

During a medical assessment, the doctor may be able to feel the undescended testicle if it is palpable. Approximately 80% of cryptorchidism is palpable.

Typically, the testicle is towards the inguinal canal end, a passageway that transports the spermatic cord to the penises and scrotum.

It would be unpalpable if a physician could not detect the undescended testicle. Further, it would be at:

  • The abdomen is the least likely site for a testicle that has not descended.
  • Inguinal: The testicle has made its way into the inguinal canal. However, it is not quite far enough to detect via touch.
  • The testicle seems extremely tiny or has never developed, making it atrophic or nonexistent.

Cryptorchidism Complications

Testicles should be slightly lower than body temperature to let them mature and operate appropriately. Further, this cool climate is at the scrotum. The following are some of the consequences of cryptorchidism.

Testicular cancer

Testicular cancer generally starts in the cells generating immature sperm in the testes, and it’s unclear what causes such cells to become cancerous. Moreover, testicular cancer is more likely in men with an undescended testicle.

Undescended testicles in the belly are more dangerous than those in the groin. Moreover, when both testicles are damaged, the risk is higher. Surgically removing an undescended testicle may reduce but not prevent testicular cancer incidence in the future.

Fertility Issues

Men with cryptorchidism are likely to experience poor sperm quality, low sperm count, and impaired fertility. So the reason behind it could be improper testicle growth, and it can worsen if left untreated for a long time.

Other issues due to the undescended testicle’s unusual position include:

Testicular Torsion

The spermatic cord’s twisting is known as testicular torsion. The spermatic cord houses nerves, blood vessels, and tubes responsible for transporting semen from the testicles to the genitals. This painful disorder prevents blood from reaching the testicle.

It is possible that the testicle will be lost if not addressed soon. Undescended testicles experience testicular torsion ten times more frequently than regular testicles.

Trauma

In case the testicle is in the groin, strain against the pubic bone may cause injury.

Inguinal hernia

A part of the intestines may protrude into the groin if the passage between the abdominal and the inguinal canal is excessively loose.

Cryptorchidism Treatment

Cryptorchidism treatment aims to reposition the undescended testicle in the scrotum to its correct position. Treatment before turning one year may reduce the chance of undescended testicle issues like infertility and testicular cancer. Although it is preferable to have surgery when the kid is younger, it is advisable to perform the surgery before the child reaches the age of 18 months.

Surgery frequently rectifies an undescended testicle, and the surgeon inserts the testicle into the scrotum with care and sutures it (orchiopexy). Further, the surgery is possible either through open surgery or laparoscopy.

In rare situations, the testicle may be undeveloped, malformed, or dead tissue. So the surgeon will remove the testicular tissue in either of the cases.

If your child has an inguinal hernia linked with cryptorchidism, the doctor will repair the hernia while performing the surgery. 

Following the surgery, the doctor will monitor the testicles to ensure that they can grow, function correctly, and remain in position. Monitoring might involve the following:

  • Physical examinations
  • Examinations of the scrotum with ultrasound
  • Hormone levels tests

While there are hormone treatments, doctors don’t prefer them as they are less effective than surgery. 

Your healthcare professional may offer hormone treatment in rare circumstances, mainly when the testicles are close to the scrotum. The doctor administers the child a sequence of hCG (human chorionic gonadotropin) shots so that the testicles might descend to the scrotum.

The most frequent surgical method for treating a singular descending testicle, orchiopexy, is close to a 100 per cent success rate. Following surgery, males with a single undescended testicle have normal fertility. At the same time, men with two undescended testicles have just 65% fertility. The chance of testicular cancer decreases with surgery. However, it doesn’t eliminate it.

Final Say

Premature newborns are more likely to have cryptorchidism, although full-term babies may still have the chance. Further, your baby will not experience any discomfort or other indications due to the problem in most circumstances. 

Moreover, your infant may need surgical procedures or other therapy if the testicles do not drop into the scrotum on their own before six months. The sexologist in Jaipur will usually prescribe surgery before your baby’s first year to correct undescended testicles. Undescended testicles may cause infertility later age if not treated.

Frequently Asked Questions

Q1. Can people with cryptorchidism have children?

Cryptorchidism is not a life-threatening disorder, although it might cause reproductive issues later in life. This is because sperm production requires a specific temperature in the testicles. The testicles are frequently warmer than they otherwise would be when they are not in the scrotum, which might impact sperm production.

Q2. Is cryptorchidism cancer?

No. Yet not treating cryptorchidism might lead to testicular cancer.

Q3. Does Cryptorchid affect men?

Undescended testicles, also known as cryptorchidism, are a fairly common and normally painless congenital condition in which one or both of a baby’s testicles (testes) have not moved into the proper position. One to 2 percent of male infants is affected.

Q4. Can cryptorchidism affect erection?

Abieyuwa Emokpae has warned that babies born with undescended testicles stand a high risk of developing testicular cancer, infertility, and erectile dysfunction later in life if the anomaly is not corrected on time. He said the condition, known as cryptorchidism, is a congenital disorder and is usually detected at birth.

Q5. Is cryptorchidism genetic?

Cryptorchidism is a common congenital anomaly that shows familial clustering and increased prevalence in first-degree relatives, suggesting that genetic factors contribute to the etiology.

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