Cryptorchidism is a male problem that means absence of one or both testes in the scrotal sac. It is a relatively common congenital defect that is usually self-limiting, but sometimes it requires a surgical intervention. It may cause serious complications including infertility.
The testicles are formed during the intrauterine development in the male fetus. The primary testes are located deep within the abdomen and they gradually descend through the inguinal canal into the scrotum. Disorders of testicular descend are typical for preterm boys (one third of preterm male newborns). However, testes may not be descended even in boys carried in term and they descend in the first year of their life. When this does not happen, there is something wrong – the testicle is either mechanically blocked in the abdomen or the mechanism fails that ensures its descent. This failure may be due to low level of testosterone hormone.
Proper function of the testes needs lower temperatures than in the abdomen, only about 32°C. Scrotal sac ensures this temperature and therefore, the testicular descend is inevitable for their proper function. In incomplete descent, the testis is exposed to higher temperatures. In such situation, it takes approximately two years to irreversibly damage the testicular tissue. Damaged testis does not produce sperm and when the damage is bilateral, the affected boy turns infertile. In addition, undescended testis damaged by increased temperature in the abdominal cavity has a much higher risk of developing a testicular cancer. For these reasons, it is necessary to deal with an undescended testis before two years of age.
The diagnosis is usually stated by a pediatrician, who does not find one or both testes in the scrotum. The diagnosis is confirmed by an ultrasound, which can locate the undescended testicle.
The treatment can be conservative or surgical. Conservative therapy means administration of the hormone testosterone that affects testicular descent. The second option is a surgical intervention when the affected testicle is located, freed and moved into the scrotum by the surgeon.