Undescended testes (cryptorchidism)

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What is Undescended testes?

Undescended testes or cryptorchidism occurs when one or both testicles fail to move into the scrotum prior to birth. The testicles develop before birth in the abdominal cavity and normally descend into the scrotum before birth. The testicles are the male sex gonads which produce sex hormones (such as testosterone which produces male secondary sex characteristics) and sperm for reproduction.

Cryptorchidism by definition suggests a hidden testicle: a testicle that is not within the scrotum and cannot be manipulated into the scrotum by several months of age.

Who gets Undescended testes?

Undescended testes is a relatively common condition affecting approximately one in twenty term males and one in three pre-term males. However, around 65% of the testicles will descend by 9 months of age. By the age of one year most will have descended and the prevalence falls to less than one percent which is similar to that seen in adults.

Cryptorchidism can affect one or both testes and approximately 10% of cases are bilateral. For unilateral cases the left testicle is more commonly affected.

Studies have shown that the prevalence of cryptorchidism varies geographically but it is not clear whether this is due to genetics or environmental factors. (e.g. endocrine disrupters and lifestyle) is unclear.

Cryptorchidism occurs more commonly among patients with congenital disorders of testosterone secretion or action (e.g. Kallmann syndrome- where there is a defect in the development of certain nerve pathways in the brain that help testosterone secretion), abdominal wall defects, neural tube defects, cerebral palsy, and various genetic syndromes including trisomy 18 (three copies of chromosome 18) and Noonan syndrome.

Predisposing Factors

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.

The mechanisms responsible for normal testicular descent are not well understood, which therefore makes it difficult to understand the reason why undescended testes occur in some males. There is some genetic component, as one study has concluded that 6% of fathers of males with undescended testes also had the condition.

Progression

Most testicles that are undescended at birth complete their descent within the first few months of life. Those that do not descend themselves will require surgical manipulation to get them into and attached to the scrotum (orchiopexy, orchidopexy).

Research suggests that changes related to fertility occur in the undescended testicle in a child as young as one year of age. Thus it is best to treat the condition surgically before these changes occur. In addition, since spontaneous descent rarely occurs after the child is six months of age, the optimal time for surgical correction is as soon as possible after he is six months of age. Men with a history of undescended testes are at greater risk of infertility, malignancy, trauma and tortion later in life.

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