Why should a testicle be in the scrotum?
During intrauterine development, the testicles form in the abdominal cavity and only towards the end of pregnancy descend through the inguinal canal into the scrotum. This arrangement is not accidental: the temperature in the scrotum is several degrees lower than body temperature, and it is precisely this that is necessary for the normal maturation of sperm.
If the testicle remains in the abdominal cavity or inguinal canal, it is constantly in overheated conditions. Already during the first year of life, changes begin to occur in its tissue: the number of cells from which sperm are subsequently formed decreases.
That is why the modern approach does not involve long waiting, but timely surgery: the sooner the testicle is in the right conditions, the higher the chance of preserving its function.
Types and what is important to distinguish
- True cryptorchidism - the testicle is located along its normal path of descent, but has not reached the scrotum: in the abdominal cavity, inguinal canal or at the entrance to the scrotum
- Ectopic testis - the testicle has deviated from the normal path and is located in an atypical location
- Retractile (migrating) testicle - periodically rises from the scrotum due to increased muscle tone, but can be brought down by hand and remains there; This is a variant of the norm that requires observation rather than surgery
- Acquired cryptorchidism - the testicle, previously located in the scrotum, has risen over time; requires surgical treatment
- Anorchia - absence of a testicle
Risk factors
- Prematurity - the shorter the gestational age, the higher the likelihood
- Low birth weight
- Cryptorchidism in a father or brother
- Multiple pregnancy
- Maternal smoking during pregnancy
- Maternal diabetes mellitus
- Genetic syndromes and disorders of sex development
- Anomalies of the anterior abdominal wall
In a significant proportion of boys born with an undescended testicle, it descends on its own in the first months of life. However, after six months, the likelihood of spontaneous descent decreases sharply, and further waiting becomes meaningless.
Why is cryptorchidism dangerous?
- Impaired spermatogenesis and decreased fertility, especially with bilateral lesions
- An increased risk of developing a testicular tumor continues after surgery, and in both testicles
- Increased risk of testicular torsion
- More common combination with inguinal hernia
- Risk of injury to the testicle located in the inguinal canal
- Psychological discomfort in a teenager with an empty scrotum
- Possible decreased testosterone production in bilateral cryptorchidism
Diagnostics
- Examination by a pediatric urologist or surgeon in a warm room, with the child in a calm state
- Determining whether the testicle is palpable and whether it can be brought down into the scrotum
- Ultrasound of the groin area and abdominal cavity is an auxiliary method, with an intra-abdominal location the information content is limited
- MRI in selected cases
- Diagnostic laparoscopy is the most accurate method for a non-palpable testicle; allows for simultaneous treatment
- Hormonal and genetic examination for bilateral non-palpable cryptorchidism - it is important to exclude a violation of sex formation
Treatment and timing
The main method is orchiopexy: an operation to lower the testicle into the scrotum with fixation. Modern recommendations indicate the importance of its implementation at an early age.
- Observation in the first months of life - spontaneous descent is possible
- Referral to a surgeon if cryptorchidism persists after six months
- The optimal timing of surgery is usually between six and eighteen months of life
- Open orchiopexy for a palpable testicle
- Laparoscopic surgery for intra-abdominal location, if necessary in two stages
- Simultaneous elimination of concomitant inguinal hernia
- Removal of a testicle if it is severely underdeveloped or in adult men with a long-standing intra-abdominal location - the decision is made individually
- Hormonal therapy is used to a limited extent and does not replace surgery
In adult men with previously undiagnosed cryptorchidism, the tactics are different: the risk of the tumor, the condition of the second testicle and age are taken into account. The decision is made individually by the urologist.
Observation after treatment
- Follow-up examinations to assess testicular position and growth
- Ultrasound of the scrotum as prescribed by a doctor
- Teaching a teenager to self-examine the testicles is a mandatory part of supervision.
- Spermogram in adulthood when planning pregnancy
- Monitoring testosterone levels with a history of bilateral cryptorchidism
- Lifelong vigilance for testicular tumor
Where to be examined and operated on in Tashkent
Diagnosis requires an examination by a specialist, and in case of a non-palpable testicle, the opportunity to perform laparoscopy, which is both a diagnostic and therapeutic procedure.
In Tashkent, consultation, surgical treatment and follow-up for cryptorchidism, as well as examination of adult men with a history of cryptorchidism, are carried out at the UROLOGIC COMPLEX medical center and at the Tashkent Medical Park clinic.
It is important for parents to remember: waiting “until it goes away on its own” after six months is not justified and works against the child. Clinic contacts and online registration are below on the page.
