Definition
Undescended testicle (cryptorchidism) is a testicle that hasn't moved into its proper position in the bag of skin hanging behind the penis (scrotum) prior to the birth of a baby boy.
About 2 to 5 percent of baby boys are born with one or two undescended testicles. An undescended testicle is more common among baby boys born prematurely, or before 37 weeks. It's rare for boys with cryptorchidism to have two undescended testicles.
For most boys born with one or two undescended testicles, the problem corrects itself within the first few months of life. If your infant has an undescended testicle that doesn't correct itself, surgery can usually be used to relocate it into the scrotum.
Complications
In order for testicles to develop and function normally, they need to be slightly cooler than normal body temperature. The scrotum provides this cooler environment. Until a boy is 3 or 4 years old, the testicles undergo changes that affect how well they function later.
- An undescended testicle isn't in a cooler environment. This might increase the risk of complications later in life. These complications include:
Testicular cancer. Testicular cancer usually begins in the cells in the testicle that produce immature sperm. What causes these cells to develop into cancer is unknown. Men who've had an undescended testicle have an increased risk of testicular cancer. - Fertility problems. Low sperm counts, poor sperm quality and impaired fertility are more likely to occur among men who have had an undescended testicle.
Other complications related to the abnormal location of the undescended testicle include: - Testicular torsion. Testicular torsion is the twisting of the spermatic cord, which contains blood vessels, nerves and the tube that carries semen from the testicle to the penis. This painful condition cuts off blood to the testicle. If not treated promptly, it may result in the loss of the testicle. An undescended testicle increases the risk of testicular torsion.
- Trauma. If a testicle is located in the groin, it may be damaged from pressure against the pubic bone.
- Inguinal hernia. An undescended testicle may be associated with an inguinal hernia. If the opening between the abdomen and the inguinal canal is too loose, a portion of the intestines can push into the groin.
Your doctor can easily determine that a testicle hasn't descended into the scrotum. The goal of further examination is to locate the position of the testicle and monitor changes in its position. If the testicle is in the groin, your doctor may be able locate it by touch. If it can't be felt (nonpalpable), then he or she will likely refer you to a pediatric urologist for further tests. About 20 percent of undescended testicles are nonpalpable.
If your son has a nonpalpable testicle, the pediatric urologist may order one or more of the following procedures:
Ultrasound. An ultrasound is a noninvasive device that uses sound waves to create images of internal structures of the body. An ultrasound may enable the pediatric urologist to locate a nonpalpable testicle, particularly if it's located within the groin.
Treatments and drugs
The goal of treatment is to move the undescended testicle to its proper location in the scrotum. Early treatment may lower the risk of complications of an undescended testicle, such as the risk of infertility and testicular cancer.
Surgery An undescended testicle is usually corrected with surgery. The surgeon carefully manipulates the testicle into the scrotum and stitches it into place. This procedure usually requires relatively small incisions and may be performed with laparoscopic devices.
When your son has surgery will depend on a number factors, such as your son's health and how difficult the procedure might be. Your surgeon will likely recommend doing the surgery after your son is 3 to 6 months old and before he is 15 months old. Early surgical treatment appears to lower the risk of later complications.
In some cases, the testicle may be poorly developed, abnormal or dead tissue. The surgeon will remove this testicular tissue.
If your son also has an inguinal hernia associated with the undescended testicle, the hernia is repaired during the surgery.
After surgery, the surgeon will monitor the testicle to see that it continues to develop, function properly and stay in place. Monitoring may include:
- Physical exam
- Ultrasound examination of the scrotum
- Tests of hormone levels
- Hormone treatment Hormone treatment involves the injection of human chorionic gonadotropin (HCG). This hormone could cause the testicle to move to your son's scrotum, but hormone treatment is usually less effective than surgery is. There's some evidence that hormone treatment may contribute to early onset of puberty (precocious puberty).
- Other treatments If your son doesn't have one or both testicles — either missing or didn't survive after surgery — you may consider saline testicular implants for the scrotum that can be implanted during late childhood or adolescence. These implants — testicle-shaped nodules filled with a fluid — result in the "appearance" of two testicles in the scrotum.
- If your son doesn't have at least one healthy testicle, your doctor will refer you to a hormone specialist (endocrinologist) to discuss future hormone treatments that would be necessary to bring about puberty and physical maturity.
So please say a little prayer for Caleb that this corrects itself soon. I can't handle him having surgery without Chris home.
