Cryptorchidism refers to a condition when one or both testicles have not descended into the scrotum of the baby by the time he is born. In most of the cases, it’s only one testicle that remains undescended. This condition is commonly seen in at around 10% of the male babies. Typically the problem sets itself right within 3 months after the baby is born. If the testicles don’t descend within 3 months period, medical intervention would be required.
What happens during the development of foetus into a baby?
After an egg is fertilized, the zygote that is formed will contain both XX chromosomes from the mother and XY chromosomes from father. At this stage, the zygote will have all capabilities to develop into any one particular gender as decided by the chromosomes combination. In case of male babies, the male reproductive parts develop and during 8th month, the testicles descend from the abdomen into the scrotum through a path called ‘Inguinal Canal’. This is the canal through which the tubes and blood vessels connecting to the testicles and to the upper parts of the body pass through. Testicles are a very important part of male reproductive system as they produce sperms and an important male hormone, testosterone.
Abnormal development of genitals can also be due to Androgen Insensitivity Syndrome, a genetic disorder when a male foetus does not respond to male hormones to develop the male genitalia. In such cases, babies may develop a vagina without ovaries or fallopian tubes but still have testicles in the inguinal canal.
How are undescended testicles diagnosed by a doctor?
In most of the cases (around 80%), the testicles are palpable. (They can be felt by the doctor while they are still in the inguinal canal area). Only in 20% of the cases, they remain undetectable with touch, unpalpable. In case of unpalpable testicles, they may be present in:
- Abdomen – this is a least common place for testicles to remain
- Inguinal Canal – They may be present in the inguinal canal but may not be detectable by hand and they are yet to descend.
- Atrophic or Absent – There are cases where the testicles have not formed at all.
Under what circumstances, a mother can give birth to a baby with Cryptorchidism?
- If the baby gets delivered prematurely.
- If the baby has not developed after a certain stage. Such babies also have low birth weight.
- Down’s Syndrome and/or other conditions that slow down fetal growth.
- Hereditary issues with development of genitalia.
- Consumption of tobacco and related products by mother during pregnancy.
The exact reason for Cryptorchidism is still not known.
In cases when the testicles are not detectable by hand, the doctor may require few scans or tests to be done on the baby such as an ultrasound scan to see the exact location of the testicles. Other tests may also be done such as MRI with a contrast agent wherein the doctor injects an agent into blood stream that helps to clearly locate the testicles in the scan.
A laparoscope (a small tube with camera) may be inserted through the abdomen of the baby to look for the testicles. The same instrument may be used to correct the issue if possible. As a last resort, an open abdomen surgery may have to be performed.
In 50% of the infants whose testicle has not descended, the problem rectifies itself within 3 months. In very few cases, the testicle doesn’t descend even after 6 months. In such cases, Orchidopexy will be performed.
Orchidopexy – a surgery to push down the testicle in to it’s rightful place
If the testicle doesn’t descend on it’s own, then a surgery will be performed to push it down into the scrotum. Once the testicle is pushed down, the inguinal canal will be sealed to prevent the testicle from moving up. This surgery is performed when the child is between 6 to 18 months of age. Delaying the procedure may result in testicular cancer or infertility.
Infertility is a result of the testicle staying in a warmer region of the body than descending into the scrotum. Higher body temperature hampers the production of sperms. Chances of getting testicular cancer in men with undescended testicle are less than 1%. Though very less, it is a possible complication.
One other complication that may arise out of undescended testicle is ‘testicle torsion’. In such cases, the nerves, blood vessels and the tubes (comprise the spermatic cord) that carry semen between the testes to the penis gets twisted. When the blood vessels get twisted, the blood supply to the testicles is stopped and the testicle dies off. In some cases, the pressure from pubic bone can also damage the undescended testicle.
Risks associated with Orchidopexy
As with any surgery, Orchidopexy also comes with a risk of damaging the vas deferens. Vas deferens is the pathway from testicle to the prostate that carries the sperms. If the vas deferens is damaged, sperms will not be able to travel out of the penis from that particular testicle.
Cryptorchidism is a condition which corrects itself in 50% of the cases and in rest of the cases; it is treatable with a surgery. You will need an experienced sexologist or a sexual health surgeon to perform the surgery without damaging the vas deferens