The human body is made up of several parts that we like to compare to machine gears, which need to be “whole” and receive proper maintenance in order for it to work in sync. So it is also with the human reproductive system, which are formed in the last months of the gestational phase. In the case of men, the baby boy’s testicles, still developing, are still formed inside the abdomen , starting to move through the inguinal canal and finally reaching the scrotum where it will remain for life. When there is any complication in this trajectory, causing one or both testicles not to reach the scrotum, it is called cryptorchidism.
What is Cryptorchidism?
Cryptorchidism or undescended testicles as it is popularly called by medicine is the name given to a genital alteration in males considered very common. It is the name given for the absence of testicles in the scrotum or the presence of a single testicle. Characterized as unilateral when there is a single testicle and bilateral when both testicles are absent, being divided into two types:
- Congenital cryptorchidism
- Acquired Cryptorchidism
Congenital cryptorchidism is considered to be the absence of one or both testicles in the baby, shortly after birth. As the male reproductive system finishes its development in the last months of intrauterine development , in this case one or both testicles failed to reach the scrotum as they should.
It is considered cryptorchidism acquired when the baby is born with its testicles properly located in the scrotum, but after a certain period one or both testicles are no longer observed in the scrotal area.
Causes of Cryptorchidism
The causes of cryptorchidism have not been clarified yet, but scientific studies on the subject point to great possibilities of being the result of genetic factors during pregnancy or even the influence of environmental factors. But among the most consistent main causes is prematurity at birth, or the birth of underweight babies for gestational age .
Diagnosis of Cryptorchidism
The diagnosis of cryptorchidism is basically clinical and can be identified after a simple but very thorough physical examination. Where it will be necessary to observe and evaluate the position, the testicular volume and also the mobility of the testicles that may point to other factors such as hernias, penile size, the hydrocele (accumulation of fluid in the testicular area), in addition to the position of the urethral meatus, which is the exit of urine in the penis.
Normally the cryptorchidic testicles can be easily palpated facilitating the localization, which in 80% of the cases are between the abdomen and the scrotum, making it easier to treat. In cases where they are not easily felt, the testicles can still be found in the abdominal cavity pointing to a more complex procedure and specific treatment.
The treatments of cryptorchidism will depend on the medical evaluation and the choice of the best procedure for the case. However, in the case of congenital cryptorchidism, where babies are already born with the absence of one or two testicles, it is usually recommended that parents wait until the baby’s six months of life , to see if there is no natural descent of the testicle into the pouch scrotal, without having to perform any procedure or treatment.
After this period, if there is no spontaneous descent, the best corrective intervention is evaluated. It is recommended that the surgical intervention takes place between six months to 12 months of the baby’s life, with the maximum period for correction up to 18 months of life. The surgical treatment for correction of testicular positioning has as main objectives to optimize testicular function , avoid future complications such as hernias and testicular torsions and reduce the chances and facilitate the diagnosis of tumors in the testicles.
For testicles that can be palpated even outside the scrotum, the surgical procedure is indicated to correct the testicular position, bringing it to the testicular bag. Testicular positioning will be evaluated and the type of procedure to be performed will be evaluated there, which may be inguinal or scrotal. In the case of testicles that are not palpable, the recommended surgery is abdominal and performed by laparoscopy, which is simpler, faster and the healing is very smooth.
One of the major concerns in the case of cryptorchidism is the issue of fertility. But research indicates that patients who have only one testicle that has not descended into the scrotum, have lower fertility rates, but can be parents, in the same proportion compared to patients who have both testicles in the correct position.
But surgical correction is necessary, in order to guarantee the correct production of sperm, in adequate quality and quantity during ejaculation . If the testicles are not corrected, the undescended testicle can compromise the production of sperm and the hormone testosterone causing infertility .
In the case of patients with bilateral cryptorchidism (absence of both testicles in the scrotum), fertility rates are minimal. Therefore, surgical treatment is essential in the correct period, throughout the first year of life, preventing infertility from being an irreversible situation.
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Another medical concern surrounding cryptorchidism, which has been evaluated in several medical studies, is the increased risk of tumors in the testis in patients with the problem. Studies show that the risk is 2 to 5 times higher compared to men who were not born with cryptorchidism. This is because, possibly, these patients are already born with a genetic predisposition for this type of cancer . Even after performing the indicated treatment and surgical intervention, it is necessary to recommend self-examination in the testicles, in order to notice any type of alteration in advance.
My name is Dr. Alexis Hart I am 38 years old, I am the mother of 3 beautiful children! Different ages, different phases 16 years, 12 years and 7 years. In love with motherhood since always, I found it difficult to make my dreams come true, and also some more after I was already a mother.
Since I imagined myself as a mother, in my thoughts everything seemed to be much easier and simpler than it really was, I expected to get pregnant as soon as I wished, but it wasn’t that simple. The first pregnancy was smooth, but my daughter’s birth was very troubled. Joana was born in 2002 with a weight of 2930kg and 45cm, from a very peaceful cesarean delivery but she had already been born with congenital pneumonia due to a broken bag not treated with antibiotics even before delivery.