Undescended testicles, or cryptorchidism

Undescended testicles, or cryptorchidism, is a condition where one or both of a baby boy’s testicles (testes) have not moved into their proper position in the scrotum by the time of birth. It’s one of the most common disorders of the male genital organs in newborns. Cryptorchidism can affect approximately 1 to 4% of full-term and up to 30% of premature male infants. The condition can involve one (unilateral) or both (bilateral) testicles.

Causes

The exact cause of undescended testicles is not fully understood, but it is believed to involve a combination of genetics, maternal health, and environmental factors. Factors that may increase the risk of cryptorchidism include premature birth, low birth weight, family history of the condition, maternal smoking or alcohol use during pregnancy, and conditions of the mother that affect the pregnancy hormones.

Symptoms

The primary symptom of cryptorchidism is the absence of one or both testicles from the scrotum. This can be observed and diagnosed by a physical examination shortly after birth or during infancy.

Diagnosis

Cryptorchidism is diagnosed through a physical examination. The doctor may attempt to locate the undescended testicle by palpation (feeling with fingers). If the testicle cannot be felt, additional imaging tests such as ultrasound, MRI, or laparoscopy might be used to locate it.

Treatment

Treatment for undescended testicles aims to move the testicle into the scrotum and is usually recommended within the first year of life to minimize the risks of infertility and reduce the risk of testicular cancer later in life. Treatment options include:

1. Hormonal therapy: Injections of human chorionic gonadotropin (hCG) may stimulate the testicle to descend into the scrotum in some cases, although this method is less commonly used and has variable success rates.
2. Surgical treatment (Orchidopexy): This is the most common treatment for cryptorchidism. The surgery involves locating the undescended testicle and moving it into the scrotum. The procedure is highly successful and is usually performed on an outpatient basis.

Complications

If left untreated, undescended testicles can lead to several complications later in life, including:

• Infertility: Cryptorchidism can affect the production of sperm, reducing fertility, especially if both testicles are undescended.
• Testicular cancer: The risk of developing testicular cancer is increased in men who had an undescended testicle, even after corrective surgery, although the overall risk remains low.
• Testicular torsion: Undescended testicles have a slightly increased risk of twisting (torsion), which can cut off the blood supply to the testicle.
• Hernia: The same open channel that allows the testicles to descend can also allow the intestines to move into the groin or scrotum, forming a hernia.

Outlook

The outlook for boys with undescended testicles is generally excellent, especially when the condition is treated early. Most boys will have normal fertility and sexual function. Regular follow-up into adulthood is recommended for those who have had cryptorchidism, primarily to monitor for signs of testicular cancer.