Cryptorchidism, often referred to as an undescended testicle, is a condition where one or both of a baby boy's testicles haven't moved down into the scrotum (the sac behind the penis) as they should. Instead, the testicle or testicles remain in the abdominal area or groin. This condition can raise a baby's risk for complications later in life, including hernias, testicular torsion (a twisting of the testicle that cuts off blood supply), and a higher lifetime risk of testicular cancer.
Typically, a baby's testicles descend into the scrotum during the final months of pregnancy. If they haven't made it down by the time the baby is born, doctors usually give them a bit more time, as the descent might happen on its own up to about 6 months of age. If the testicle still hasn't descended after that timeframe, the pediatrician will examine the baby. The doctor can usually confirm cryptorchidism by gently feeling the scrotal sac to check for the absence of one or both testicles.
It's vital that cryptorchidism is spotted and treated early, ideally within the baby's first year or so. Early detection allows for prompt treatment, which may involve hormone therapy or a surgical procedure. Addressing the issue sooner rather than later is key to minimizing the potential for long-term health complications.
Confirming a diagnosis
A pediatrician usually identifies cryptorchidism during the standard check-ups throughout a child's development, especially if the testicles haven't moved into the scrotal sac by the time the child is one year old. To figure out the testicles' exact position, the pediatrician will perform a physical exam, which includes palpating (gently feeling) the scrotum and groin area.
Based on the exam findings, the doctor can check for any abnormalities and classify cryptorchidism into two primary types:
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Bilateral cryptorchidism: This means both testicles are absent from the scrotum.
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Unilateral cryptorchidism: This means only one testicle is absent from one side of the scrotum.
It’s important to identify and treat this condition between the ages of 6 and 18 months, according to the American Academy of Pediatrics (AAP) and the American Urological Association (AUA). Timely treatment helps prevent complications like the development of hernias, testicular torsion, and infertility, and it lowers the elevated risk of testicular cancer.
Possible causes
Cryptorchidism can occur due to a variety of factors. Sometimes, it's a consequence of genetic changes, hormonal deficiencies in the baby, or weakness/absence of the abdominal muscles necessary for the descent. Other times, it may be related to factors associated with the mother during pregnancy, such as obesity or gestational diabetes, smoking, advanced maternal age, or prolonged exposure to certain chemicals, like pesticides.
Additionally, certain conditions in the baby can increase the risk of an undescended testicle. These include premature birth, low birth weight, cerebral palsy, and Down syndrome.
Treatment options
The pediatrician will guide the treatment plan for cryptorchidism. Initially, they may recommend hormone therapy. This often involves a series of injections of human chorionic gonadotropin (hCG). The goal of this hormone is to help mature the testicle, encouraging it to descend into the scrotum. This approach is successful in up to half of all cases.
However, if the testicles haven't "come down" by the time the baby is one year old, surgery is typically required. This procedure is called an orchidopexy (or orchiopexy) and is performed to move the testicle into the correct place in the scrotum. Surgery is most commonly indicated for cases of unilateral cryptorchidism.
If the absence of testicles is detected much later in life, sometimes the testicles may need to be surgically removed (orchiectomy) to prevent future complications. Unfortunately, this may lead to sterility.