Cryptorchidism is characterized by the absence of one or both testicles in the scrotum. If it doesn't resolve within 6 months, orchidopexy surgery is indicated
Cryptorchidism occurs when one or both testicles do not descend into the scrotum at birth. Cryptorchidism can cause testicular cancer and/or infertility, so it's important to be vigilant about treating it properly before the age of 1.
Pediatric urologist Dr. Ubirajara Barroso Jr. says that the incidence of cryptorchidism is higher in premature infants. According to the specialist, around 3% of boys are born with cryptorchidism and approximately half of this number will have the testicle descended into the scrotum by the sixth month of life.
According to the Brazilian Society of Pediatrics (SBP)cryptorchidism affects approximately 30% of premature newborns and around 3.4% of full-term newborns. The incidence of cryptorchidism decreases from 3.4% at birth to 0.8% at 12 months of age and remains at 0.8% from childhood to adulthood.
If the testicles are not in the scrotum by the age of 6 months, it is very important to see a pediatric urologist for correction.
In this article, you will understand what cryptorchidism is, its possible causes, consequences and the surgical intervention commonly used to correct it, known as orchidopexy. Read on and find out.
What is cryptorchidism?
Cryptorchidism is a condition characterized when one or both testicles do not descend into the scrotum during fetal development or childhood.
Generally, the testicles descend from the abdomen into the scrotum before birth or in the first few months of life. However, in cases of cryptorchidism, this process does not occur as it should.
According to SBP data, unilateral cryptorchidism is the most common, accounting for 75% to 90% of cases. The bilateral type, in which both testicles are outside the scrotum, is less common, occurring in only 10% to 25% of cases.
How is cryptorchidism diagnosed?
Dr. Ubirajara Barroso points out that the presence of cryptorchidism can be suspected during pregnancy. He points out that observing the testicles in the scrotum is one of the signs that the fetus is male. When the testicles are not seen on the ultrasound scan during the pregnant woman's prenatal care, the following possibilities can be considered: the position of the fetus does not favor the scan and it should be repeated; the baby may be female; there may be a genital malformation; or there may be cryptorchidism.
"According to a study published by Gideon et al. in the Journal of Ultrasound in Medicinethe scrotum is visible in all cases in the last week of pregnancy. Occasionally, there may be a false diagnosis of cryptorchidism, but it is rare to find cryptorchidism after birth when prenatal ultrasound shows the testicles in the scrotum," he says.
Dr. Barroso points out that after birth, the physical examination is fundamental for locating the testicles. They can be palpated in the inguinal canal (in the groin) or not located in this examination (non-palpable testicles). "When both testicles are not palpable, a karyotype is essential to determine the sex of the baby. Congenital adrenal hyperplasia, which occurs in people with chromosome 46, XX (female), can have male genitalia, despite having a uterus, fallopian tubes, ovaries and vagina," he explains.
A karyotype is a genetic test that gives a visual representation of an organism's complete set of chromosomes. This analysis is generally used in medical diagnoses to identify chromosomal abnormalities, such as genetic syndromes, chromosomal anomalies and genetic disorders.
Dr. Ubirajara Barroso Jr. also points out that ultrasound can be used in case of doubt, especially in babies born with bilaterally non-palpated testicles. "Magnetic resonance imaging can help in cases of obese boys, when testicular palpation is more difficult. Testicles that are not palpated should be assessed by laparoscopy," he adds.
Causes of cryptorchidism?
The entire mechanism of testicular descent is still not fully understood, which is why the exact causes of cryptorchidism are not fully understood. "The testicle doesn't descend due to inaction of some substances that promote or facilitate its descent, such as chorionic gonadotropin and insulin-like growth factor, which are important for migration," explains Dr. Barroso.
Factors that can cause the testicles not to descend include the absence of these hormones, as occurs in conditions such as:
- Placental insufficiency;
- Presence of syndromes;
- Threat of abortion;
- Poorly responsive testicular receptors;
- Mechanical obstruction of testicular descent;
- Torsion of the testicle and other conditions.
Treatment of cryptorchidism
Normally, the testicle descends by the age of 3 months, but in some cases it can occur as early as 6 months, especially in premature babies. When this doesn't happen naturally, most specialists consider the ideal age to correct cryptorchidism to be in the first 6 to 12 months of life. In children over the age of 1, correction should be carried out at the time of diagnosis.
According to Dr. Ubirajara Barroso Jr., after the age of 6 months, the testicles will very rarely descend naturally. The pediatric urologist points out that before the laparoscopic procedure, the use of hormones such as GnRh or human chorionic gonadotropin can be a good indication to reduce the need for two-stage surgery.
Orchidopexy: surgery to correct cryptorchidism
Orchidopexy is the surgical procedure for correcting cryptorchidism. It consists of positioning the undescended testicle in the scrotum and fixing it in place. "Nowadays, most cases can be treated with a scrotal incision. We've even published our experience and a review of the literature," says Dr. Barroso.
The doctor also points out that scrotal orchidopexy has the advantages of causing less pain, being performed through just one incision, and can be approached through an incision in the middle of the scrotum (in the median raphe), leaving an imperceptible scar.
"In the case of higher testicles, positioned in the inguinal region, orchidopexy should be performed by this route, adding a new scrotal incision for fixation. In cases of intra-abdominal testicles, the approach should be laparoscopic. Testicles very high in the abdomen may require surgery in two stages. In cases of testicular absence, a silicone prosthesis can be fitted," he explains.
Risks of untreated cryptorchidism
Cryptorchidism is a condition that can carry a number of risks if not treated properly. "The scrotum has a temperature that is 3º to 4º C lower than the intracorporeal temperature. The presence of the testicle outside the scrotum means that it is subject to a 5-fold increase in the risk of testicular cancer, as well as damage to the germ cells, causing testicular atrophy," says the doctor.
The Brazilian Society of Pediatrics points out that around 10% of testicular cancer cases are related to cryptorchidism. According to the organization, patients with this condition have a 5 to 20 times greater risk of developing testicular cancer than the general population.
Infertility is also a common complication in patients with cryptorchidism. According to the SBP, it is observed in around 30 to 50% of cases of unilateral cryptorchidism and in up to 75% of cases of bilateral cryptorchidism.
Early treatment can play a crucial role in preventing or delaying the progression of testicular lesions. Acting quickly can help preserve testicular function and potentially minimize negative impacts on future fertility.
Has your son been diagnosed with cryptorchidism and not yet had an operation? Do you suspect that your son has this condition? Make an appointment with Dr. Ubirajara Barroso Jr.
READ MORE:
Video with Dr. Ubirajara Barroso explaining cryptorchidism
When should you take your son to the urologist?"My testicles haven't descended" - understand what cryptorchidism is - interview with Dr. Ubirajara Barroso on Dr. Jairo Bouer's website