Cryptorchidism is a common congenital malformation, and it occurs when the testicle has not descended into the scrotum. Find out when it occurs and how it is treated.

Cryptorchidism is a disorder known medically by the name of undescended testicle or hidden testicle, and it basically consists of a congenital anomaly, in which one or both testicles do not descend correctly. As a consequence, they tend to stay in the inguinal canal or in the abdominal cavity, not descending normally into the scrotum. In addition, the right testicle is usually the most affected.

It is, in fact, one of the causes that can cause sterility during adulthood, especially when it is not treated in time. In addition, it is a very common disorder in premature babies;  that is, in children born before completing 37 weeks of pregnancy.

What is cryptorchidism?

It is a common alteration of the normal development of the testicles. It is estimated that between 1 and 3% of children born at term suffer from it, although in the case of premature births it tends to affect around 30% of babies. However, it is estimated that more than 95% of cases, throughout the first year of the child’s life, the testicle tends to descend normally.

As we briefly explained at the beginning of this note, cryptorchidism is the absence of one -or of both- testicles in the scrotum. That is, the testicle has not descended normally into the scrotum, so it is ‘hidden’ in the abdominal cavity or in the inguinal canal.

There are two types of cryptorchidism:

  • Unilateral cryptorchidism: It occurs when only one of the testicles has not descended correctly. It is the most common congenital malformation of cryptorchidism, accounting for 85% of cases. In fact, the right testicle is usually the most affected.
  • Bilateral cryptorchidism: It occurs when neither testicle descends normally to the scrotum. It is, in fact, a less common malformation than the unilateral one.

What are the causes of cryptorchidism?

There are several causes that can cause the testicle to not be able to descend into the scrotum normally. For example, it may be due to anatomical irregularities that interfere or block the normal path that goes to the scrotal bag, or a hormonal alteration that prevents or delays the normal development of the baby.

In any case, here are the main causes of an undescended testicle:

  • Genetic causes or chromosomal alterations: alterations in the Y chromosome, Klinefelter syndrome, Prader-Willi syndrome and Kallman syndrome, among others.
  • Anatomical alteration.
  • Mechanical obstacle -as we go or spermatic nerves- that appears during the normal migration of the testicle.
  • Very narrow inguinal canal.
  • Hormonal defect or insufficiency: deficiency of testosterone, AMH, HCG, LG or FSH, among others.
  • Lack of intra-abdominal pressure.

How is it diagnosed in babies?

Most commonly, the diagnosis is made after palpation of the baby’s scrotal bag by a pediatrician, pediatric urologist, or pediatric surgeon. This palpation can be carried out in the child at birth or in a routine check-up that is carried out later.

When one of the testicles – or both – are not located in the scrotum and therefore cannot be found during palpation, the most common is to perform an abdominal ultrasound. And if, finally, with this medical test it is not possible to find them, other tests such as ultrasound can be performed to visualize the testicles in the inguino-scrotal path, or an MRI.

How is it treated?

The most common is to wait during the first year of the baby’s life, since it is common for the testicle to descend spontaneously during the first 6-12 months of the child’s life.  However, when this does not happen, it is possible to opt for different treatments:

  • Hormone treatment:  It consists of the administration of hormones such as testosterone and beta-hCG, which stimulate the descent of the testicles. If administered, it is necessary for parents to examine the baby periodically after the first month, then after six months, and finally every year until puberty. However, it is a treatment that is not widely used today due to its side effects.
  • Surgery:  This is a surgery known as orchiopexy. It tends to be performed before 2 years of age, and the sooner it is performed, the better prognosis it will have, since it will positively influence fertility, reduce the risk of testicular cancer and also there will be a greater recovery of testicular volume.

What are the consequences if it is not treated in time?

When cryptorchidism does not correct itself, and in addition, adequate medical treatment is not followed in order to solve the problem, serious consequences can occur in the long run, since the testicular tissue is seriously damaged by being in an abnormal position, which anatomically does not correspond to it. And what are those consequences?

  • Sterility:  It occurs when the testicular tissue has been damaged, so it is quite possible that the production of sperm in adulthood is little or no.
  • Testicular torsion It occurs when the spermatic cord undergoes a torsion, interrupting the blood supply to the testicle.
  • Testicular cancer:  Due to an increase in temperature and an alteration in the normal development of the testicle, men with cryptorchidism have a higher risk of developing a tumor in the testicle.
  • Inguinal hernia:  It consists of the protrusion or exit of a part of the intestine through an opening that we find in the abdominal wall in the groin.

As we can see, if your child has recently been diagnosed with cryptorchidism in the first place you should not worry. The most normal thing is that the undescended testicle descends into the scrotum during the first year of life. And if you don’t, there are effective medical treatments that can be of great help. The key is to treat it as soon as possible, always following the advice of the pediatrician or children’s urologist.


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