Undescended testicles problem occurs in 3-9 percent of babies if they are not premature.
Terms such as undescended testes, retractile testes, or empty scrotum are often used to refer to cryptorchidism . All these terms are also correct, since cryptorchidism occurs when there is no descent of the testicles towards the scrotum before birth, although as we will see there are different cases.
The testes develop in the fetus from the sixth week of gestation. The final position within the scrotum occurs in several phases. First, they remain in the baby’s abdomen and later the testicles slide towards the 15th week of gestation and for another ten weeks they remain in an intermediate place. From the 28th week, they begin to descend towards the scrotum , completing the process around the 35th week of pregnancy.
CRYPTORCHIDISM IS MORE COMMON IN PREMATURE BABIES
As we mentioned at the beginning, there are several different cases of cryptorchidism:
– Congenital undescended testicles : In this condition, the testicles are outside the scrotal bag, either in the abdomen, in the inguinal or scrotal path. They may or may not be palpable, but in any case it is not possible to move them to the scrotum manually.
– Actually absent testicle : This is also known as anorchia and occurs when the testicle is not really present, after having tried to locate it with complementary imaging tests or surgery.
– Ectopic testicle : It occurs when the testicle is at a different point from the usual path that it must follow.
– Acquired undescended testicles : We are talking about testicles that, having already descended, rise again. That is why it is important to follow up until the age of five or ten.
– Elevator or retractable testicle : In this case we would not even speak of a real cryptorchidism, since it occurs due to a reflex called cremasteric, which makes the testicle manage to ascend even when the scrotum has already descended. You can also descend spontaneously or by helping manually. However, it may be that it does not descend definitively or correctly, so further monitoring is necessary in this case as well.
CAUSES OF CRYPTORCHIDISM
There is no single known cause, but there are several factors that can cause cryptorchidism in children. First, children are more likely to develop cryptorchidism if they have a family history of both cryptorchidism and impaired sexual differentiation.
On the other hand, within gestational and perinatal factors, those that increase the incidence of cryptorchidism are the following:
– That the woman smoked during pregnancy or even used nicotine substitutes.
– Alcohol during pregnancy also increases the chance that the baby will have cryptorchidism.
– That the mother suffers from gestational diabetes mellitus .
– That the pregnancy has occurred through artificial insemination.
– Estrogens have been administered to the mother during pregnancy.
– That the newborn, even being full term, has low weight during pregnancy and at birth.
– That the pregnancy is multiple.
– That the baby at the time of delivery is presented breech.
Cryptorchidism can be part of other genetic diseases and syndromes. Cryptorchidism can occur as an isolated disorder in healthy children. As we have said, it is something relatively frequent and it is not painful for the baby. In fact, it is the most common congenital malformation of the male external genitalia. However, it can also be another symptom of other endocrine diseases, other morphological abnormalities or genetic syndromes.
PHYSICAL EXAMINATION IS THE USUAL WAY TO DETECT CRYPTORCHIDISM.
This is why the physical examination by the pediatrician is so important. It is the usual way to detect cryptorchidism, which does not usually go unnoticed by pediatricians. In the first examination after birth, the pediatrician will palpate the scrotal bag and thus detect if it is empty or not . If it is, it will gently travel the path that the testicle normally makes, from top to bottom, trying to locate it. It is possible that, when in doubt, the pediatrician will request some additional test, such as an ultrasound.
CRYPTORCHIDISM CAN LEAD TO FERTILITY PROBLEMS IN ADULTHOOD IF NOT TREATED EARLY
And, the main problem with cryptorchidism is the subsequent complications that it can bring with it. These complications include the following:
– Infertility : It is the most frequent complication, especially in cases of bilateral cryptorchidism that has not been operated on before the age of four years.
– Malignancy: This term refers to the fact that in children with cryptorchidism the risk of developing testicular cancer is four or five times higher. It is estimated that the sooner it is intervened, the lower the risk of suffering it in the future.
– Testicular torsion: It consists of the torsion of the spermatic cord that supports the testicles in the scrotum. If this happens, the blood supply is cut off.
– Inguinal hernia: The risk of suffering from this problem is also increased, whereby part of the contents of the abdominal cavity can come out through a point of the inguinal canal.
Therefore, early detection in children may allow designing the appropriate treatment with which to stop long-term consequences. However, there is considerable controversy as to the appropriate age to start treatment and how to carry it out.
Keep in mind that some cases of cryptorchidism resolve spontaneously during the baby’s first year of life. However, as we have said, in most complications, the sooner it is intervened, the lower the probability of suffering later consequences. Here is the debate.
In general, treatment begins around a year and a half, although more and more doctors are recommending intervention to achieve the descent of the testicles between the sixth month and one year of life, to improve fertility in adult life . In any case, it is recommended to carry out the intervention before two years . There are two types of treatment, hormonal and surgical:
Hormone treatment has been used for several decades now, but its use is currently not highly recommended. First of all, because of its low efficiency. Hormones can cause the testicle to descend, especially in cases where it is not too far from the scrotum, but it is likely to rise again. In addition, there are important side effects such as alterations in the skin of the scrotum area, an early and abnormal development for the age of the testicles and penis, premature hairiness, as well as erections, changes in mood and behavior and great pain.
Surgical treatment , therefore, is the most widely accepted today. It is also called orchidopexy and is the first treatment option between six and eighteen months of age of the baby. Success rates are very high, up to 92 percent, and subsequent complications are significantly reduced.
In any case, periodic check-ups will be necessary , promoting self-exploration for the rest of life and, at 18 years, a fertility study will be recommended.
Dr. Tabriella Perivolaris, Sara's mother and fan of fashion, beauty, motherhood, among others, about the female universe. Since 2018 she has been working as a copywriter, always bringing to her articles a little of her experience and experience as a mother and woman.