What is cryptorchidism?
The testicles develop in the abdominal cavity during gestation and in the latter stages of maturation before birth, they begin to descend into the scrotum. When one or both testicles are arrested in this descent, the condition is called cryptorchidism or undescended testicles.
The Glickman Urological and Kidney Institute is a world leader in treating both pediatric and adult urologic problems. The Institute's surgeons have pioneered diagnostic and surgical procedures that are minimally traumatic and significantly shorten recovery periods.
About 30% of premature male babies will have cryptorchidism and perhaps 3.4% of male newborns will have the condition. The only symptom is the absence of one or both testes in the scrotum.
Cryptorchidism is not considered a serious medical condition although it should be corrected early. When the testes remain in the scrotum there is a risk that fibrous proteins such as collagen may begin to deposit around the undescended testicles and impair their function.
The scrotum, because it is exposed to the air, keeps the testes 1 to 2 degrees cooler than other organs. This temperature difference enhances the creation and maturation of sperm. The temperature difference is lost when the testes remain in the abdomen.
Men with cryptorchidism are thought to be at greater risk of testicular cancer and fertility problems. Microscopic changes have been noted in testicles when left in the abdomen for longer than a year although the implications of such changes is not clearly understood. In addition, testicles lodged in the abdomen tend to be close to the surface and are at greater risk of being physically injured. Appearance may also become a concern.
A simple, routine physical examination determines if the testicles have descended. If they have not, a policy of watchful waiting is initiated because often, they will resume their journey with no outside assistance. If they have not descended after six months or longer, consideration is given to medical interventions.
Sonography may be employed to identify their state and pinpoint their location even though in many instances they can be felt as small bumps in the abdomen. Sonography bounces sound waves off of tissues and structures and uses the echoes to form an image, a sonogram. Blood tests may be run to determine hormone levels. An imbalance of hormones may be one of the reasons why the testicles have failed to descend.
Treatment may be hormonal, surgical or a combination of both. Some testicles will respond to intra-muscular injections of the hormone hCG (human chorionic gonadotropin) by completing their descent. Orchiopexy, an operation designed to bring an undescended testicle into the scrotum, is accomplished through either an open procedure or laparoscopically.
In the open procedure, a small incision in made in the groin to locate and manipulate the undescended testicle and another is made in the scrotum. The testicle is moved into the scrotum and a few sutures are placed to stabilize it and hold it in place. Laparoscopic orchiopexy is essentially the same procedure conducted with a slender viewing scope inserted in the abdomen.
Although both procedures are outpatient procedures, laparoscopic diagnoses and surgery uses smaller incisions resulting in minimal blood loss and more rapid recovery. Glickman Urological and Kidney Institute surgeons are pioneers in laparoscopic approaches. Both open and laparoscopic orchiopexy procedures have a very high success rate. The patient is followed at one to two week intervals, primarily to evaluate healing from the surgical procedures.