Cryptorchidism

Cryptorchidism (Undescended testis) is a developmental defect characterized by failure of one or both testes to descend into the scrotum. The testes normally develop in the abdominal cavity during early fetal life and descend into the scrotum along the main branch of the gubernaculum during the seventh to ninth months of fetal life. 

Pathophysiology

Failure of one testicle to descend, usually the right one, is more common than bilateral failure. There are two types of cryptorchidism - true and ectopic.

A true undescended testicle has never reached the scrotum but may be located in the abdomen above the inguinal ring.

In ectopic undescended testicle, the testicle has passed through the inguinal canal and descended along one of the four other branches of the gubernaculum into the base of the penis over the pubic bone, perineum, femoral sheath, or superficial inguinal area. The various possible causes of this condition include testicular failure, mechanical obstruction, and deficient gonadotropic stimulation. Along with cryptorchidism, there may also be an upper urinary tract anomaly, congenital hydrocele, or an inguinal hernia on the same side as the  undescended testis. Torsion or twisting of the spermatic cord of the undescended testicle may also occur.

Sign and symptoms

An undescended testis is generally smaller than one that has descended, is not likely to produce sperm normally, and is more prone to develop a malignancy after puberty. If the testis is left in the abdomen after the child is 5 years of age, the higher temperature at this site than in the scrotum causes the sperm-forming cells to  degenerate. If both testes are undescended, sterility may result.

Treatment

Two types of management may be used for children who have cryptorchidism. If the testis is below the external inguinal ring, hormonal therapy given in the form of human chorionic gonadotropin (hCG) may be successful. Since many testes descend spontaneously during the infant's first year, hormonal therapy is used after the child is 1 year of age. If the testis is located inside the inguinal ring or in an ectopic position, surgical intervention (orchiopexy) is carried out. If hormonal therapy is not successful, elective orchiopexy is done by the time the child is 2 to 3 years old because degenerative changes begin in the germinal epithelium of the undescended testis around this time. Some surgeons prefer to wait until the child is 5 years of age before performing the procedure.

The parents and the child need support from the nurse and an explanation about what is to be done during this potentially emotional situation. The parents may be anxious about the possibility of their child being infertile.