Review on Undescended Testes Cryptorchidism

During fetal development, a male’s testicles form in the abdomen alongside the kidneys. Normally, just before birth, the testicles are supposed to descend into the scrotum, the external sac meant to house them. But in some instances, one or both testicles do not move downward by the time of birth, resulting in one or two undescended testes.
Undescended testicles, also known as cryptorchidism, are painless. Some will eventually descend into their proper position without treatment within the first three to four months of life. The condition does, however, increase the risk of infertility. Cryptorchidism literally means hidden or obscure testis. It is synonymous with incomplete testicular descent. The condition may be unilateral or bilateral.

Treatment for undescended testes

Undescended testis is a condition when the testis cant be found in its normal location inside the scrotum. Undescended testis is one of the most common abnormalities seen in newborn babies.Cryptorchidism (or undescended testes) is a condition seen in newborns when one or both of the male testes have not passed down into the scrotal sac. Thirty percent of cases are bilateral (involve both testes). Cryptorchidism is more commonly seen in premature males because the testes do not descend from the abdomen to the scrotal sac until the seventh month of fetal development.

Symptoms of Undescended testes

The symptoms of undescended testes are quite visible. One or both of the testicles appear to be either missing or cannot be felt in the scrotum. If both of testicles are undescended, the scrotum, will look unusually small. If only one testicle is affected, the srotum may look lopsided. If your baby’s testicle appears to be there sometimes and not there during other times, it is considered retractile, a normal condition that requires no treatment.
• Asymmetrical appearing or undeveloped scrotal sac
• Inability to feel testes in the scrotum
• Usually a painless condition

Causes of Undescended testes
Undescended testes may occur for several reasons. While prematurity is a leading cause, other causes may include hormonal disorders, spina bifida, retractile testes (a reflex that causes a testicle to move back and forth from the scrotum to the groin), or testicular absence.

Who is affected by undescended testes?
• Undescended testes occurs in approximately 3 percent of male infants
• Twenty-one percent of premature male infants have an undescended testis
• Undescended testes occurs in 3 percent to 4 percent of full term infants
• There is also a genetic component: 6 percent of fathers of males with undescended testes also had the condition.

Diagnosis of Undescended Testes
When we see a child with an undescended testicle, Diagnosis can be classified according to following categories

Testicular retraction
This is the most common factor resulting in the inaccurate diagnosis of an undescended testicle. It is common in boys 5-6 years old and is due to a hyperactive cremaster muscle reflex. This is basically a variation of normal. In children from 1 year to 11 years of age, 80% of fully descended testes can withdraw from scrotum and leave an empty scrotum behind due to cremaster reflex. If a testicle can be milked down to the bottom of the scrotum, it is considered a retractile testis, and no further treatment is needed. This phenomena usually disappears by puberty.

Cannilicular testis
Here the testicle located above its natural position in the scrotum, but still outside the abdominal cavity. Tension from the external musculature of the body wall prevents normal descent into the scrotum.

Intra-Abdominal testes
Here the testicle is located inside the abdominal cavity residing in a position along its pathway of natural descent. In such a position, it is not amenable to future examination by a physician, and it is at risk of becoming cancerous.

Ectopic testicle
Here the testicle may be found in regions not in the usual pathway of descent into the scrotum. Five major sites of ectopia are perineum, femoral canal, superficial inguinal pouch, suprapubic area, and contralateral scrotal pouch. The etiology is believed to be misdirected attachment to the scrotum.

Absent testicle
Such a phenomena of absent testicle can be bilateral (affecting both sides). It is believed to be associated with in utero torsion, vascular insult, or agenesis.

X-Ray studies
Generally radio logic imaging is not reliable. Ultrasound can help identify a testicle located in the inguinal canal, but is of limited use for intrabdominal testes. MRI and CT scan can be useful for intrabdominal testes, but they are often difficult to use on small children and have a high rate of false negative results.