UNDESCENDED TESTICLES

CRYPTORCHIDISM, A CASE OF UNDESCENDED TESTICLES

I attended an obstetrics seminar last fall and got really thrilled by the many number of first time mothers who so much wanted to know about what to expect when their babies would be delivered. Most were really anxious to know how long they were supposed to breastfeed having in mind that they too had to go out to fend, and I can tell you there were many solutions including storing breast milk in the refrigerator for up to four days, I had not imagined that could be possible. As it were, a woman in her mid-thirties and a second time mother wanted to know why one of her son’s testicles failed to fall into place, even after birth. I share a few highlights on what you could be hearing for the first time or have possibly observed in your toddler and shrugged it off. Stay with me; undescended testicles (also known as cryptorchidism) is a condition in which one or both of a baby boy’s testicles (testes) have not moved down into their proper place in the scrotum. As a baby boy grows inside his mother’s womb, his testicles form inside his abdomen and move down (descend) into the scrotum shortly before birth. But in some cases, that move doesn’t happen, and the baby is born with one or both testicles undescended. The majority of cases are in male babies born prematurely.

Spontaneous descent after the first year of life is uncommon. In the United States, the prevalence of cryptorchidism ranges from 3.7% at birth to 1.1% from age 1 year to adulthood. Internationally, prevalence ranges from 4.3-4.9% at birth to 1-1.5% at age 3 months to 0.8-2.5% at age 9 months.

Undescended testicles move down on their own in about half of these babies by the time they’re 6 months old. If they don’t, it’s important to get treatment. The testicles make and store sperm, and if they don’t descend they could become damaged. This could affect fertility later in life or lead to other medical problems.

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. Cryptorchidism on both sides can rarely be a sign of an inter-sex disorder.

How to tell if your son has undescended testes

Especially for new mothers who have not raised sons before, it is important that you always examine your boy child, the best time being during diaper change or when bathing. That goes without saying even for girls. Mothers should be curious enough to know if there are any abnormalities present, new behaviors not previously seen. Take more time to learn your child’s genitalia, and how he responds to touch especially for boys. Whether his penis becomes excited to erect when touched or his balls are in place should be a norm during diaper change and bath time, and no mother should shy away from that.  Look out for these symptoms to know if your son has undescended testicle(s)

  • Not seeing or feeling a testicle where you would expect it to be in the scrotum is the main sign of an undescended testicle.

But where could be the scrotum? Many people are not sure where to feel, or “look” for the missing testicle. Unless it proves otherwise, every parent should be able to locate an undescended testicle if it appears in the following regions.

Abdominal:

  •  The least common location for an undescended testicle is in the abdomen.
  • Inguinal: The testicle has moved into the inguinal canal, but not far enough to be detectable by touch.
  • Atrophic or absent: The testicle is either very small or it has never formed in the first place.

Are there risk factors for cryptorchidism?

Almost everyone who attended the seminar including myself wanted to know if there are any avoidable risk factors that bring about the testicles not to descend into the scrotum. The idea of having one or both of the testicles not descend into their rightful pocket, as novel as it may sound, meant a really new worrying reality that could happen to anyone’s child. Deliberations were rife, but it was not clear what really causes cryptorchidism. However, the following were thought to contribute in one way or the other to undescended testicles in newborns:

  • Low birth weight
  • Premature birth
  • Family history of undescended testicles or other problems of genital development.
  • Conditions of the fetus that can restrict growth, such as Down syndrome or an abdominal wall defect.
  • Alcohol use by the mother during pregnancy.

  • Cigarette smoking by the mother or exposure to secondhand smoke.

  • Parents’ exposure to some pesticides.

Are there any complications that could arise as a result of untreated undescended testicle(s)?

If there is one thing that we should always practice, is having the ingenuity to do what we can when we can. As the old adage goes, prevention is better than cure. Most conditions, when left untreated, or rather unattended to, even when they present as minute problems, will often develop into more complex problems that we would have addressed. Treating an undescended testicle when your son is still a baby might lower the risk of complications later in life

What complications then could arise if cryptorchidism is not corrected?

  • Infertility. This is most common when both testes don’t descend. Low sperm counts, poor sperm quality and decreased fertility are more likely to occur among men who’ve had an undescended testicle. This can be due to abnormal development of the testicle, and might get worse if the condition goes untreated for an extended period of time.
  • Risk for testicular cancer. This risk increases greatly by age 30 or 40.
  • Inguinal hernia.
  • Testicular torsion. This occurs when tissues around the testicle (also known as the “testis”) are not attached well. This can cause the testes to twist around the spermatic chord. When this happens, it cuts off the blood flow to the testicle. It can cause pain and swelling, and should be treated as an emergency.
  • Emotional stress- As you would imagine, an empty scrotum is likely to cause psychological stress as your boy gets older and explores his genitalia, privately or among his cohorts. It is absolutely necessary to get treatment as early as possible if you notice that either one or both testes are missing.

What are the treatment options for undescended testicles?

An undescended testicle is usually corrected with surgery. The surgeon carefully manipulates the testicle into the scrotum and stitches it into place (orchiopexy). This procedure can be done either with a laparoscope or with open surgery.

Orchiopexy should not be performed before 6 months of age, as testes may descend spontaneously during the first few months of life. The highest quality evidence recommends orchiopexy between 6 and 12 months of age.

I am sure you now know something about undescended testicles and will find this information helpful and useful in case you were wondering what to do with your newborn whose testicles have not yet descended. Please let us know if you have any questions concerning this topic in our comments section.

 As always, stay well and healthy.