Cryptorchidism

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at June 22, 2016
StartDiseasesCryptorchidism

Cryptorchidism happens when the scrotum does not contain two testes. Generally, this occurs because one or both testes are not descended, yet sometimes it can be entirely absent from the body. Fortunately, it is often possible to treat this health condition if the testes still remain within the body. Cryptorchidism is also known as undescended testicle.

Contents

Definition & Facts

Cryptorchidism technically refers to any instance where the scrotum is missing one or both testes, but it is most commonly used to refer to a congenital condition. Roughly 3 out of 100 infant boys are born with cryptorchidism, but the situation generally resolves itself within the first year of life.

Testes form along the back wall of the abdomen and then travel down the path of descent to the scrotum. If a person has cryptorchidism, the missing testicle may be anywhere along the path of descent, completely absent, or so underdeveloped that it is not in the scrotum. In very rare cases, cryptorchidism can be due to an ectopic testis, which may be anywhere in the body, such as beneath the skin on the thigh.

Symptoms & Complaints

The primary symptom of cryptorchidism is a scrotum that does not contain two testicles. Typically, there are no other genital abnormalities or significant differences. However, there are some associated symptoms of cryptorchidism that occur later in life, even after the condition has been treated.

Regardless of whether the missing testes descend naturally or are fixed through surgery, men who had cryptorchidism as an infant are more likely to have trouble fertilizing an egg. Compared to men who did not have cryptorchidism, men who had one undescended testicle at birth have a four percent higher rate of male infertility. If both of a man's testicles were undescended, he would be six times more likely to be infertile.

Another symptom of cryptorchidism that becomes prevalent in adulthood is testicular cancer. For unknown reasons, men who were born with cryptorchidism have a 40 percent increased risk of developing testicular cancer in the previously undescended testicle in their thirties or forties.

The other testicle that descended normally has a 20 percent increased risk of getting testicular cancer. Men who had an undescended testicle that remained in the abdomen are more likely to get testicular cancer than men whose testes were in the inguinal canal at birth. 

Causes

Cryptorchidism is far more common among prematurely born boys because it is caused by the testes not forming properly during a woman's pregnancy. Even if a child is not premature, being at a low birth weight increases the risk of cryptorchidism. Research has found that cryptorchidism in full-term babies is most likely caused by androgen disruption during the 8 week to 14 week period of pregnancy, and both environmental factors and genetic factors make it more likely for hormone disruptions to cause this issue.

A mother who is diabetic, obese, drinks at least five drinks a week, or smokes cigarettes during pregnancy is more likely to give birth to a child with cryptorchidism. If the mother is exposed to environmental toxicants that disrupt endocrine hormones, such as some types of pesticides, cryptorchidism may occur.

Cryptorchidism does seem to have some genetic causes as well, since it is more common among patients who have other family members with the condition. If a child is born with Down Syndrome or Prader-Willi syndrome, he is also more likely to have cryptorchidism.

Diagnosis & Tests

Though it seems like establishing the absence of testicles in a patient's scrotum would be simple, diagnosing the condition can often be difficult. In order to diagnose a patient with cryptorchidism, a doctor must first make sure the patient does not have a retractile testicle which is a condition where the testicles can descend normally into the scrotum but are sometimes pulled into the body by contracting muscles.

Doctors will therefore examine the patient in certain positions and at certain temperatures that make it clear whether the testicle is undescended or merely retracted. Imaging tests, including ultrasounds and MRIs can be used to locate the missing testicle if it is not found during tests for retractile testicles. Imaging tests will also rule out the possibility of a child being intersex because they will clearly show if an ovary or uterus is present.

Treatment & Therapy

If the undescended testicle is still in the inguinal canal, doctors usually recommend waiting a bit before further treatment. Most cases of cryptorchidism resolve themselves in the first few months of birth, and it may be possible to facilitate a natural descent with regular hormone therapy.

If the testicle does not descend naturally, an orchiopexy is typically performed to move the testicle down into the scrotum. This is a fairly simple surgery as long as the undescended testicle is close to the scrotum, and it is often an outpatient procedure. However, if it is far up in the abdomen, it may take several surgeries to slowly move the testicle down without cutting off its blood flow.

In some cases, the undescended testicle is deemed unviable, so it is removed from the body instead of being transferred to the testicle. There is no way to treat cryptorchidism that is caused by a completely missing testicle, though some men choose to get a testicular implant later in life for aesthetic, social, sexual, or psychological reasons.

Prevention & Prophylaxis

Most methods of preventing cryptorchidism rely on the behavior of the mother during pregnancy, and the child cannot do anything to prevent cryptorchidism from occurring. To prevent cryptorchidism, it is necessary for the mother to avoid anything that could harm the fetus or disrupt hormones during pregnancy.

Certain beauty and bath products and pesticides can alter hormones, so these may need to be avoided. Maintaining a healthy weight and getting proper nutrition is essential to ensuring that the fetus forms properly and is not born prematurely. Drinking alcohol and smoking can increase the risk of cryptorchidism as well as cause a host of other severe health problems for the fetus, so they should be avoided.