- Mar 30, 2007
Early diagnosis and management of the undescended testicle are needed to preserve fertility and improve early detection of testicular malignancy. Physical examination of the testicle can be difficult; consultation should be considered if a normal testis cannot be definitely identified. Observation is not recommended beyond one year of age because it delays treatment, lowers the rate of surgical success and probably impairs spermatogenesis. By six months of age, patients with undescended testicles should be evaluated by a pediatric urologist or other qualified subspecialist who can assist with diagnosis and treatment. Earlier referral may be warranted for bilateral nonpalpable testes in the newborn or for any child with both hypospadias and an undescended testis. Therapy for an undescended testicle should begin between six months and two years of age and may consist of hormone or surgical treatment. The success of either form of treatment depends on the position of the testicle at diagnosis. Recent improvements in surgical technique, including laparoscopic approaches to diagnosis and treatment, hold the promise of improved outcomes. While orchiopexy may not protect patients from developing testicular malignancy, the procedure allows for earlier detection through self-examination of the testicles.
Symptoms: If your son has an undescended testicle, you'll observe that his testicle or testes have not completely moved down into the scrotum. This means the testes may still be in the abdominal cavity or partway down the inguinal canal — the passageway between the abdominal wall and the scrotum. In very few cases, testicles may never have formed. If both testes are completely undescended, it's common to do chromosome testing to verify the sex of the baby.
Causes: In the fetus, the testes begin their development in the abdomen then normally move downward through the inguinal canal and into the scrotum.
Anything that affects that process of descent is thought to play a role in causing cryptorchidism, although the exact cause is unknown. Proposed possible causes include hormonal abnormalities during gestation or an abnormally developed testis.
[FONT="]If one or both testes are completely absent, torsion — a twisting of the blood supply to the gonads during gestation — may be the cause. Torsion of the testes can occur in descended testicles also. Sometimes, the gonads simply do not develop.[/FONT]
[FONT="]Diagnosis: [/FONT][FONT="]Undescended testicle is typically diagnosed during the newborn examination. The doctor examines your baby's groin area, from the hip down to the scrotum.[/FONT][FONT="][/FONT]
[FONT="]Diagnosis is made if the testicle is not in its normal location in the scrotum. The doctor will then attempt to locate the testicle in the inguinal canal or elsewhere in the groin area. Ultrasound may be needed to locate the testicle(s) when in the abdomen.[/FONT]
[FONT="]Imaging studies such as X-rays or ultrasound may be used to help diagnose the condition. The doctor may also refer your baby to a pediatric urologist — a specialist in the area of urinary and reproductive organs — for further evaluation.[/FONT]
[FONT="]A suspected case of undescended testes must be differentiated from retractile testes, whereby a testicle moves back and forth between the groin and the scrotum. In the past retractile testes weren't considered a clinical problem needing treatment. But recent studies show that retractile testes can later ascend (acquired undescended testicle), requiring treatment.[/FONT]
Complications: Undescended testicles can cause complications including:
- Testicular cancer later in life.
- Fertility problems. Lowered sperm count, sperm quality and fertility rates; sterility.
- Testicular torsion. The blood supply to the testicles is cut off due to twisting of the spermatic cord.
- Inguinal hernia. The intestines are pushed through the inguinal canal.
- Male breast cancer.
- Blunt trauma or injury to the testicle due to compression against the pubic bone.
[FONT="]Treatment: [/FONT][FONT="]Testicles rarely descend on their own after six months of age. Once the doctor has determined the testicle is unlikely to descend naturally, hormonal therapy, surgery or a combination may be recommended.[/FONT]
[FONT="]Because descent of the testicle is partially regulated by hormones, normal descent can sometimes be induced with hormone therapy using human chorionic gonadotropin (HGC) HCG is the only hormone approved for treatment of undescended testicle in the United States. HCG is administered by injection, generally twice weekly for four weeks. Success rates are best when the testicle is located at the greatest distance from the scrotum.[/FONT]
[FONT="]More commonly, the doctor may recommend a simple corrective procedure known as orchiopexy or orchidopexy, which is typically performed when the boy is between 1 and 2 years of age. This involves making an incision at the groin and another at the scrotum to manipulate and stitch the testicle into place.[/FONT]
[FONT="]If the testicle can't be located, laparoscopic techniques may be needed. Laparoscopy involves a tiny video camera that's usually inserted in the abdominal area and navigated into the groin to help locate the testicle. Treatment options will be considered once the testicle is found.[/FONT]
[FONT="]In some cases the testicle may be completely absent. This can be confirmed with surgery or laparoscopy. In cases where both testes are absent, the doctor may want to check the baby's hormones and chromosomes to asses the baby for characteristics of an ambiguous genitalia disorder.[/FONT]
[FONT="]It's advantageous to correct undescended testicle as early as possible because sperm cell density has been shown to decrease as early as 1 year of age with this condition. In addition, risk of testicular cancer is higher in men with uncorrected conditions.[/FONT]