Undescended Testis: Symptoms, Causes and Treatment

Undescended testis, also known as cryptorchidism, is a condition where one or both of a male infant’s testicles fail to move into the scrotum before birth. This condition is relatively common, affecting about 3% of full-term and 30% of premature male infants. The condition can lead to various complications if left untreated, making early diagnosis and management crucial. This blog post delves into the symptoms, causes, types, and treatment options for undescended testis.

Symptoms

The primary symptom of an undescended testis is the absence of one or both testicles from the scrotum. This condition is usually detected during a routine physical examination shortly after birth or during well-child visits. Other symptoms may include:

• Empty Scrotum: The scrotum appears underdeveloped or smaller than usual.
• Inguinal Hernia: A bulge in the groin area, which can be associated with an undescended testicle.
• Palpable Testicle: In some cases, the testicle may be felt in the groin area but not in the scrotum.

Causes

The exact cause of cryptorchidism is not always clear, but it is believed to result from a combination of genetic, maternal, and environmental factors:

1. Genetic Factors: Certain genetic mutations and chromosomal abnormalities can interfere with the normal descent of the testicles.
2. Hormonal Factors: Hormones, particularly those involved in the development and function of the male reproductive system, play a crucial role in the descent of the testicles. Any hormonal imbalance can affect this process.
3. Maternal Factors: Maternal health and behaviors during pregnancy, such as smoking, alcohol consumption, and certain medications, have been linked to an increased risk of cryptorchidism.
4. Environmental Factors: Exposure to certain environmental toxins and endocrine disruptors can affect fetal development and increase the risk of undescended testis.

Types

Undescended testis can be classified into several types based on their location and nature:

1. Abdominal Testis: The testicle is located within the abdomen and has not descended into the groin or scrotum.
2. Inguinal Testis: The testicle is located in the inguinal canal but has not descended into the scrotum.
3. Prescrotal Testis: The testicle is located just outside the scrotum, near the base of the penis.
4. Ectopic Testis: The testicle has deviated from its normal path and is located in an unusual position, such as the thigh or perineum.
5. Retractile Testis: The testicle can move back and forth between the scrotum and the groin and is not considered a true undescended testis. It often resolves on its own.

Diagnosis

Diagnosis of cryptorchidism typically involves a physical examination by a pediatrician or urologist. In some cases, imaging tests such as ultrasound or MRI may be used to locate the undescended testicle, particularly if it is not palpable.

Complications

If left untreated, undescended testis can lead to several complications:

1. Infertility: The higher temperature inside the abdomen or groin can impair sperm production and function.
2. Testicular Cancer: There is an increased risk of developing testicular cancer in undescended testicles.
3. Testicular Torsion: The undescended testicle is more prone to twisting, which can cut off its blood supply and cause severe pain and damage.
4. Inguinal Hernia: The presence of an undescended testicle can increase the risk of developing an inguinal hernia.

Treatment

The primary goal of treatment for cryptorchidism is to move the testicle into the scrotum to reduce the risk of complications and preserve normal testicular function. Treatment options include:

1. Watchful Waiting: In some cases, the testicle may descend on its own within the first few months of life. Regular monitoring by a pediatrician is essential during this period.
2. Hormonal Therapy: Hormone injections (hCG or GnRH) may be used to stimulate the descent of the testicle. This approach is less commonly used and is typically considered if the testicle is located near the scrotum.
3. Surgery (Orchidopexy): Surgical intervention is the most common and effective treatment for undescended testis. The procedure, called orchidopexy, involves making an incision in the groin or abdomen to locate the testicle and then moving it into the scrotum. This surgery is typically performed between 6 months and 1 year of age.
4. Laparoscopy: For testicles located in the abdomen, a minimally invasive procedure called laparoscopy may be used. This involves inserting a small camera and surgical instruments through tiny incisions to locate and move the testicle.

Prognosis

The prognosis for boys with an undescended testis is generally good, especially if the condition is treated early. Most boys who undergo treatment will have normal testicular function and a reduced risk of complications. Regular follow-up is essential to monitor testicular health and development.

Conclusion

Undescended testis, or cryptorchidism, is a condition that affects a significant number of male infants. Early diagnosis and treatment are crucial to prevent potential complications such as infertility, testicular cancer, and testicular torsion. Understanding the symptoms, causes, types, and treatment options can help parents and caregivers make informed decisions about their child’s health. If you suspect your child has an undescended testicle, consult a pediatrician or urologist for proper evaluation and management.