Description, causea and Risk Factors:
Alternative Name: Cryptorchidism, empty scrotum, monorchism, Vanished testes , and retractile testes.
A testis that has failed to descend into the scrotum; there are palpable and nonpalpable (impalpable) variants.
When the baby is formed in the womb, the testis is initially formed inside the baby's belly. As the fetus grows, the testes gradually descend out of the body and reach the sac. When this does not happen, or is arrested half way, the result is Undescended Testis (UDT). Undescended testicles are fairly common in premature infants. They occur in about 3 - 4% of full-term infants. In most cases the testicles descend by the time the child is 9 months old.
Testicular development is determined by the influence of the SRY gene (sex-determining region Y gene) on the Y chromosome of the fetus. This influences the germ cells to produce testosterone and Mullerian inhibiting substance which control descent of the testis. Maldescent of the testis occurs in 0.8% of boys.
Testicles that do not naturally descend into the scrotum are considered abnormal. These undescended testicles have an increased likelihood of developing cancer, regardless of whether or not they are brought down into the scrotum.
Bringing the testicle into the scrotum maximizes sperm production and increases the odds of good fertility. It also allows examination for early detection of testicular cancer.
Low birth weight.
Maternal exposure to estrogen during the first trimester.
Small size for gestational age.
Having a father or brother who had the condition increases the risk.
There are usually no symptoms, except that the testicle cannot be found in the scrotum. Adult males with an undescended testicle may have problems with infertility.
Diagnosis of undescended testisis made through physical examination at birth to locate the testis. It is sometimes diagnosed by prenatal ultrasound. If one testicle is undescended, the scrotum appears unbalanced. A congenitally absent testicle may result from an abnormality in testicular blood vessels in utero. This condition is diagnosed using a blood test to determine the level of gonadotropin, which is a hormone that stimulates development of the testes.
Treatment may include:
Most cases get better on their own, without any treatment. Medical or surgical correction of the condition is usually successful. Usually the testicle will descend into the scrotum without any intervention during the first year of life. If this does not occur, the child may receive hormone injections (B-HCG or testosterone) to try to bring the testicle into the scrotum.
Hormonal Therapy - administration of certain hormones may stimulate the production of testosterone, which helps the testes descend into the scrotal sac. This is not routinely used for treatment of truly undescended testes.
Surgical Repair - a surgical repair to locate the undescended testicle and advance it to the scrotal sac may be recommended by your child's physician. This surgery, called orchiopexy, is usually performed between months 6 and 18 and is successful in 98 percent of children with this condition. Earlier surgery may prevent irreversible damage to the testicles. This damage can cause infertility.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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