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Definition of Cryptorchidism (Undescended testicles)Cryptorchidism means "concealed testicle." It occurs when one or both testicles get stuck at some point in fetal descent. Ectopic maldescent means one or both testicles have strayed from the normal path of descent. The usual place for a missing testicle is the groin. Both these conditions are often called undescended testicles. Description of Cryptorchidism (Undescended testicles)The testes start to develop 40 days after conception. They grow inside the fetal abdomen. Near the end of the eighth month, they travel down the inguinal canal and through the abdomen wall. They reach their low-hanging position in the scrotum a few days before birth. A post-birth check ensures that they have safely descended. Cryptorchidism is a congenital disorder when one or both of a newborn's testicles fail to descend into the scrotum. Although this condition may occur on both sides, it more commonly affects the right testis. Because the testicles normally descend into the scrotum during the eighth month of gestation, undescended testicles most commonly affect newborns. In about 80 percent of affected infants, testicles descend spontaneously during the first year; in the rest, the testicles may or may not descend later. Of full-term babies, 3.4 percent are born with undescended testicles. Of these, 50 percent descend in the first month of life. Of premature babies, 30 percent have undescended testicles. Of these, 80 percent are safely down by the first month. In most cases, the natural history of an undescended testis is spontaneous descent, usually occurring within the first year of life and, in most cases, within the first three months of life. If no descent is observed by about 1 year of age, urologic consultation is indicated. If the bilateral condition persists untreated into adolescence, it may result in sterility, make the testicles more vulnerable to injury, and significantly increase the risk of testicular cancer. Treatment of Cryptorchidism (Undescended testicles)Orchiopexy is a surgical procedure that secures the proper position of a testicle in the scrotum. When successful, orchiopexy decreases the risk of sterility, testicular cancer, and testicular injury from abnormal positioning. If a testicle is missing or must be removed, a prosthesis is inserted to achieve a normal appearance and to foster the person's positive body image. Orchiopexy for correction of an undescended testicle is usually performed in children ages 1 to 6. Orchiopexy is performed when other treatments such a hormonal therapy fail. It is performed under general anesthesia. If there is testicular torsion (twisting), the surgeon makes an incision in the scrotal skin and attempts to untwist and stabilize the spermatic cord. To treat an undescended testicle, the surgeon makes an incision in the groin or lower abdomen to expose the testicle and a small incision to open the scrotum. He or she then frees the testicle, lowers it into the scrotal sac, and secures it with stitches. If both testicles are undescended this procedure is repeated for the other testicle. In two-stage orchiopexy, an alternative procedure, the surgeon brings the testicle down into the scrotal sac and stitches it to the thigh; then, 2 to 3 months later, she embeds it in the scrotal sac. If the spermatic cord is too short to accommodate repositioning the testicle, the surgeon may sever the spermatic cord before replacing the testicle in the scrotal sac. After completing the procedure, the surgeon closes the incision and applies a dressing. Complications of the procedure are uncommon but include hemorrhage, infection, and painful urination. Questions To Ask Your Doctor About Cryptorchidism (Undescended testicles)Is only one testis involved or is it bilateral?
Will this condition resolve itself spontaneously?
What are the risks of not correcting it?
Is infertility an inevitable consequence?
What are the risks of getting testicular cancer?
Do you recommend orchiopexy?
What are the risks and benefits of surgery?
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