Cryptorchidism: Treatments, Risks, Characteristics, Types, Causes And Symptoms

Cryptorchidism literally means hidden testicle and refers to the lack of a testicle in the scrotum. It represents one of the conditions most frequently treated by pediatricians. Despite this, there is much ignorance about cryptorchidism in babies, in fact many definitions today are quite controversial. What you should know for sure is that if the proper treatment is not carried out, cryptorchidism can lead to some complications in the future, such as a high risk of a tumor in the testicles and infertility. This congenital malformation is generated in the genitals of men, even 5% of newborns can be affected by cryptorchidism .

As your baby’s testicles begin to develop, they are in his abdomen and stay there for at least 15 weeks. From that moment the testicles begin to descend little by little through the abdominal cavity until they reach the inguinal canal, for another 10 weeks they will remain there. Already in week 28 of gestation, the testicle continues to descend until week 35, which is when it reaches the scrotum. Continue reading about cryptorchidism, when it comes to having a baby it is essential to have the appropriate information, to be able to act correctly and ensure the good health of the baby.

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What do we call cryptorchidism?

Cryptorchidism is the separation of the testicle in the scrotal sac. It usually occurs due to an abnormality when migrating the testicle. It cannot lower the testicle and cannot be felt in the sac. It does not mean that it is the same as the retractile testicle or elevator testicle, which refers to the testicle that has descended well, but sometimes it is raised and can be lowered easily. At least 30% of premature infants have cryptorchidism and between 2 and 8% of full-term babies. In most babies, it descends in the initial months and in general in 85% of babies it is unilateral, affecting mainly the testicle located on the right side.

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Disease or condition?

It is a clinical condition in which both testicles or one of them at the time the baby is born do not descend into the scrotal bag. In many cases, this condition is corrected naturally in the first 12 months of the baby’s life. Cases with a history of cryptorchidism or males that are born prematurely usually require surgery because they cannot descend naturally. Treatments can be hormonal or through surgical intervention.

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Characteristics of cryptorchidism

In particular, cryptorchidism presents as follows:

• Asymmetry and underdevelopment of the scrotal bag.
• Absence of one or both testicles in the scrotum (double-sided or simple pathology).
• The baby may complain of pain in the groin area or in his abdomen.

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Causes and symptoms of cryptorchidism

There are multiple causes that can cause cryptorchidism and some symptoms. Here are some of the causes and symptoms of this condition:

Main causes

• Governculum anomaly (in this type of anatomical anomaly the testis is inserted an epididymal ligament).
• Difficulty of the hole of the scrotal sac.
• A mechanical obstruction found when the testicle, nerves or spermatic vessels migrate or the inguinal canal may be very narrow.
• Hormonal insufficiency or defect, due to the requirement of gonadotropins for the proper development of the male sexual system.
• Cryptorchidism can be caused by a lack of abdominal pressure.
• There are also some genetic causes such as Kallman Syndrome or Prader-Willi Syndrome.

Main symptoms

At least 3% of newborns are affected by the symptoms of cryptorchidism. The best way to study the symptoms is that it can be detected in time by your baby’s pediatrician, since it is the most indicated to make the diagnosis. The natural development of the baby’s testicles are affected by this disorder, where the testicles are not located properly in the scrotum. Therefore, cryptorchidism is also called an undescended testicle.

What you should do with the symptoms of cryptorchidism or if you have detected an abnormality in the genital area of ​​your baby, it is best that you consult a trusted pediatrician immediately; especially if your baby is premature, since at least 30% are affected by this disorder at birth.

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How can cryptorchidism be detected?

The diagnosis of an undescended testicle or cryptorchidism is made by a pediatric surgeon, pediatrician, or pediatric urologist. The assessment is usually done in a warm and quiet environment. The pediatrician performs an exact palpation, determining the location of the testicles. If the pediatrician does not appreciate both testicles, he will then perform other tests such as a hormonal stimulation test. With the support of this evaluation, the pediatrician verifies the existence of testicular tissue, if it is anorchia (absence of both testicles) or intra-abdominal cryptorchidism.In some cases a laparoscopy is performed to find the testicle, it is necessary to apply general anesthesia to the baby. In other cases, an MRI or ultrasound is recommended. But in the case of cryptorchidism they are not part of the routine examinations.

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Histology of cryptorchidism

The testicles are located under the penis, in front of the perineum, between the thighs. The testicles are surrounded by a group of covers whose shape is similar to a bag, which is known as the scrotum or scrotal bag. Both gonads are not located at the same level, in most men the right testicle is higher than the left. The testicles are suspended by the spermatic cord at its lower end and are deprived of welds in a large part of the external surface, for this reason they are quite mobile in any direction, having the ability to ascend and contract to the inguinal ring.

When talking about the migration of the testicles, these come from the inner part of the abdominal cavity, to the left and right of the lumbar spine, near the kidneys. About three months into the development of the fetus, the testicles leave this area and begin their descent through the inguinal canal, crossing the abdominal wall, taking the enveloping sacs with them to their final location. When the descent is not completely carried out, cryptorchidism occurs.

As you already know, there are two male testicles and one is located on the left side, while the other is located on the opposite side. Irregularly, only one testicle can be found because the other has not developed, since there is a vas deferens or an epididymis missing, this disorder is known as monorchidism. If both testicles are missing it is known as anorchidism.

In babies the testicles are quite small, but at puberty they increase in size. Practically throughout life this size is maintained, sometimes generating atrophy during old age or may increase due to the consumption of steroids. The testicles are bluish-white in color and when they are filled with red blood. The color is due to the enveloping bags. The testicle has a hard and slightly elastic consistency, ovoid and flattened transversely .

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Consequences and risks of cryptorchidism

The consequences and risks derived from cryptorchidism are:

• Sterility: for the sperm to form perfectly, the temperature of the testicles must be lower than the body temperature, therefore its normal location in the scrotal sac.
• High risk of testicular cancer: men with cryptorchidism have a high risk of suffering from a certain testicular tumor, due to the complication to palpate the testicle properly, the cancer can be diagnosed late.
• Inguinal Hernia Hazard – Due to variation in the inguinal canal.
• Abnormal growth in the testicles: Cryptorchidism can cause a smaller size in the testicles.
• Arching or testicular torsion: in this case it is possible that the child’s testicle turns on itself and creates an obstacle to the entry of blood to the testicle through the blood vessels, causing testicular necrosis and cell death. There is a high probability of torsion in a baby with cryptorchidism.

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At what age can it be operated? How? Why?

Surgery should be carried out between the first and second year of life of the child, because after this age the testicle can show gradual alterations in the cells that produce sperm, if not corrected in time it can become a sterile testicle. A periodicity of cancer in the testicles between 10 times and 20 times higher than the normal average has been described, which is not corrected by surgical intervention. Through surgery, the testicle can be placed in a place where cancer can be detected and examined early.

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What does differential diagnosis mean?

Retractile tests and testicular ectopy can be detected by physical examination, yo-yo, or elevator. With the real lack of gonadal tissue, a differential diagnosis of the intra-abdominal tests should be made: castration, anorchy, female pseudohermaphroditism due to the transfer of transplacental androgenic substances or virilizing adrenal enzymatic defects and with other less common intersex syndrome.

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Types of cryptorchidism

Cryptorchidism has a fairly extensive definition, where it is possible to detail different situations according to the AEPED (Spanish Association of Pediatrics:

• True cryptorchidism or congenital undescended testicles: in this type of cryptorchidism in the scrotal bag, the testicle is absent. In the inguinal canal it can be palpated, but its descent to the scrotum is not possible manually.
• Testicle: one speaks of those testicles that were not in the scrotum, but during the first 12 months of life they descend and later rise again. In general, 40% of this type of cryptorchidism may later require surgical intervention, in these cases it is essential that the child be followed up to 10 years.
• Elevator testicles : the testicle is not located in the scrotum but by manual methods it manages to descend, for this reason it is not considered a true cryptorchidism. In any case, children with lift testicles have a higher risk of not descending the testicle definitively, hence the importance of observing the case in the long term.

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How does cryptorchidism affect infants?

Cryptorchidism in infants is relatively common, even among newborns at the end of gestation. At least 1 in 30 babies in late pregnancy show this condition. Your baby’s scrotum will be smaller than usual, if both testicles or one are hidden, the appearance of the scrotum is probably asymmetrical.

At the time of birth, the doctor will carefully check your baby’s genitals to check that both testicles have descended into the scrotal bag or at least into the duct above the scrotum. If 3 months have already passed and they have not descended, it is necessary to consult a pediatric urologist.

The risk of some complications can be reduced when your baby’s cryptorchidism has been treated in time, it is the best way to prevent testicular cancer or infertility in the majority of age. Preteens and infants who were not affected by cryptorchidism at birth may later notice a testicle disappear. This can be a clear sign of: the shrunken testicle moves back and forth between the groin and the scrotum, during the physical examination it can be easily guided. This is something frequent and is generated because a muscle reflex occurs in the scrotal bag. Acquired cryptorchidism or an ascended testicle, which has returned to the infant’s groin and cannot be guided into the scrotum with the hand. If you notice any changes in your baby’s genitals or are concerned about their growth,

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How to deal with the problem with the infant?

As your son grows, you need to talk openly about his testicles. When your son is in puberty you need to talk about the physical changes that are likely to be generated, show him how he can check the condition of his testicles himself.

Due to the lack of one of the testicles, your son may be a bit uncomfortable with his appearance. You may suffer from anxieties related to appearance different from your peers or friends at school. Here are some strategies that can help you deal with the problem:

• You need to explain the proper words to him when talking about his testicles and scrotum.
• Your child must understand that he is not in danger of any disease.
• Teach him that there are normally two testicles in the scrotal sac. If he is missing both testicles or one, explain in simple words what this means and that he understands that he is still a healthy infant.
• Help him respond appropriately about his condition when he is overwhelmed in conversations on the subject.
• Explain about the option of a testicular prosthesis.
• Acquire underwear that will conceal your condition a bit.
• Be on the lookout for signs of embarrassment or concern like stopping participating in your favorite sports activities.

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Risks of cryptorchidism during pregnancy

During your pregnancy it can be quite harmful to ingest painkillers such as aspirin, ibuprofen or paracetamol, especially if it is male since it may affect its ability to reproduce in the future . The ingestion of painkillers in pregnancy has a huge impact on boys, who are affected with cryptorchidism or undescended testes, according to recognized studies.

The gonad is outside the scrotum, becoming a risk element for testicular cancer and infertility in adulthood. Pain relievers lower testosterone levels during pregnancy, at which time the baby’s genitalia develop. The effect is quite similar to that generated by phthalates (compounds that help increase flexibility in plastics, which cause damage to the endocrine system).

Specialists on the subject suggest that it is essential to do in-depth research on the effects of analgesics and their incidence in cryptorchidism, especially epidemiological studies. That is why it is important that you consult your doctor before starting any pain reliever while pregnant.

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Factors that increase the risk of cryptorchidism

As for the factors that increase the risk of cryptorchidism in your baby at birth, we find the following:

• Premature birth.
• Weight failure at birth.
• Genital development problems or a history of familial cryptorchidism.
• Drink alcohol during pregnancy.
• Conditions such as abdominal wall or Down syndrome that prevent the normal development of the fetus.
• If you are a passive smoker or use tobacco during pregnancy.
• Exposure of both parents to pesticides.
• Gestational diabetes or diabetes in the mother.

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Cryptorchidism and testicular ectopia

In cryptorchidism, the normal tube of descent of the testicle is lost, at some point during the descent the testicle stops. Due to an abnormal connection, ectopy can occur in the governmental testis specifically at the distal end leading to an abnormal state of the gonad. The ectopic places are:

• Superficial inguinal: it is the most common position, the testicle after moving through the outer inguinal ring, continues its superolateral direction until it achieves a superficial positioning in relation to the aponeurosis of the greater transverse muscle.
• Crural or femoral: in Scarpa’s triangle is the testicle. The spermatic cord passes below the inguinal ligament.
• Perineal: the testicle is located on one side of the middle strip and in front of the anus.
• Paradoxical or transverse: both testicles descend in the inguinal canal.
• Penis: the testicle is located under the skin specifically at the root of the reverse of the penis.
• Pelvic: In the actual pelvic cavity is the testicle.

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Evolution of cryptorchidism in the baby

If the undescended testicle or cryptorchidism is not corrected on its own before your baby is 6 months old, some treatment is mandatory. Before the baby is 1 year old, treatment should be finished. Aggravated cryptorchidism can cause testicular cancer or sterility, due to the abnormal position of the testicular tissue which can end up being damaged.

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Recommended treatments for cryptorchidism

The most advisable thing in a cryptorchidism is a correct treatment if the testicle does not descend naturally at 6 months of the baby’s life. After this stage, the possibility of the testicle descending on its own is almost nil, with cryptorchidism remaining. Alternative therapy or hormone therapy is recommended, in addition to surgery in certain cases.

Hormonal

Human chorionic gonadotropin (HCG) and gonadotropin-releasing hormone (GnRH) are responsible for regulating the release of testosterone. Hormone therapy helps the testicles drop. HCG is injected into the muscle by the doctor, while human chorionic gonadotropin is administered through a nasal nebulizer. It is possible to combine both hormones in this treatment. In at least 20% of cases, hormonal treatment is successful. 25% is the risk of receptivity. Therefore, as parents, they should periodically examine the affected baby after the first month of life, after 6 months and annually until puberty.

Surgery

In some cases, cryptorchidism can be solved with surgery: when there is an inguinal hernia at the same time, when hormonal treatment is not successful, the abnormal position of the testicles, if the groin area has been operated or if the child is in puberty . The doctor makes a small cut in the groin area, first releasing the spermatic cord and then pulling it down. The testicles are then firmly sewn into the deepest area of ​​the scrotum.

TESTS AND DIAGNOSIS FOR POSSIBLE OPEN SURGERY OR LAPAROSCOPY

If your baby has cryptorchidism, the doctor may recommend surgery to provide diagnosis and treatment.

• Open surgery: A direct examination through a large cut is performed in the abdomen in certain cases.
• Laparoscopy: a tiny tube containing a camera is inserted through a tiny incision into the child’s abdomen. This procedure is performed for the intra-abdominal location of the testicle. During laparoscopy the doctor can correct cryptorchidism, but certain cases require additional surgical intervention. Laparoscopy can alternatively show that a testicle is not present or the cessation of function in some remaining testicular tissue.

HOW IS THE SURGICAL INTERVENTION PERFORMED AND WHEN SHOULD IT BE DONE?

When the baby is 6 months old and the testicles are not yet descending or cannot be felt, he will probably not be able to lower the testicle, this is where surgical intervention is considered. In many cases, after surgery the child returns home the same day, simply a small incision is made in the scrotum and groin. No suture is performed. On certain occasions, cryptorchidism may require the use of laparoscopy.

CAUTIONS TO BE TAKEN INTO ACCOUNT

After surgery, the doctor will check the child’s testicle to see if it is working properly, continues to develop, and remains in position. Monitoring may include an ultrasound of the scrotum, physical examination, and analysis of the child’s hormone levels.

What if cryptorchidism is not treated?

If cryptorchidism is not treated in time, the risk of developing infertility or testicular cancer increases in the next stages of your baby’s life, especially if cryptorchidism is not treated for more than two years. In rare cases, a torsion of an undescended testicle can occur, thus blocking the blood supply and causing discomfort in the scrotum or groin.

General recommendations for cryptorchidism

This pathology does not require specific eating habits. With regard to the child’s lifestyle, it is vital to protect the cryptorchid area (under the abdomen or the skin of the thigh) from trauma. Regarding food after surgery, nothing specific is required, but mobile games should be restricted. Because in the surgical incision there may be a discrepancy in the affected area.