Normally, in a newborn boy, the testes are already in the scrotum. If one or both testicles did not fall after birth, this condition is called cryptorchidism . Most often, this pathology occurs in premature babies (in about 30% of cases) and much less often in adolescents – up to 1% of cases. The problem is that the abnormal location of the male gonads often indicates a concomitant pathology and can lead to the development of serious complications: from impaired fertility to the transformation of normal cells into malignant.
Features of development and timing of prolapse of the testicles
During intrauterine development, the testicles of the fetus are laid in the retroperitoneal space, in the region of the posterior abdominal wall, where they gradually grow and develop. Approximately from the 24th-25th gestational week, they begin to descend after the gunther cord. Normally, having passed the inguinal ring and inguinal canal, by the time of the birth of the baby they should be fixed at the bottom of the scrotum.
It is important to understand that all phases of the prolapse of the male genital glands into the scrotum occur under hormonal regulation. If the first phase – the movement of the testicles in the pelvic region to the inner opening of the inguinal canals – is regulated by the Müller inhibitory factor (a substance that is produced in the cells of the testicles in the embryonic period), then the glands are lowered into the scrotum under the control of androgens. Therefore, hormonal dysfunction is one of the leading causes of cryptorchidism.
Thus, in a healthy baby, the testicles are lowered into the scrotum by the time of birth.
Causes of Cryptorchidism
Often you can find the opinion that if the boy’s testicles did not drop by the year, then this is a variant of the norm. It has been reliably established that for their life and normal functioning, testicles must necessarily be in the scrotum.
The main factors leading to cryptorchidism:
- Genetically determined anomalies in the development of the ligamentous apparatus and the membranes of the testicles.
- Various hormonal disorders (in particular, a deficiency of gonadotropins – hormonally active substances that regulate the production of testosterone and other androgens).
- Mechanical causes (the presence of fibrous adhesions in the abdominal cavity, short vascular pedicle in testicles, abnormalities in the development and location of the vaginal process of the peritoneum, etc.).
Thus, cryptorchidism is not just an isolated undescended gonads in the scrotum, but a manifestation of a systemic or hormonal disease, a connective tissue dysplasia syndrome in a child.
Types of pathology
First of all, it is important to be able to distinguish the true form of cryptorchidism from the false one. In the latter case, the organs of the reproductive system have a normal structure, and the absence of one or both testicles in the scrotum is temporary and is due to a high cremasteric reflex (the testicles are pulled in when trying to probe them).
False cryptorchidism implies periodic migration of one or two testicles at once due to high tone or irritation of the muscle that raises the testicle. In this case, the parents or the doctor can palpate the gland in the inguinal area near the inner ring of the inguinal canal and lower it to the bottom of the scrotum. Treatment is usually not prescribed.
Forms of ectopic testicles (classification based on the location of the glands):
Retention, or delay, of the testicles on the path of their passage into the scrotum cavity is also distinguished. With localization of the testis in the abdominal cavity, they speak of abdominal retention; in case of delayed glands in the inguinal canal, the pathology is called – inguinal retention.
It is extremely rare to find a cross-shaped ectopia – when, for example, the right testicle enters the left half of the scrotum.
What is the danger of pathology?
Undetected or timely uncorrected abnormal localization of the testicles always leads to the development of complications. First of all, in such boys and young men fertile function suffers (the percentage of damage to the gland tissue increases with age).
As early as 1.5 years in the testicle parenchyma, irreversible changes begin – the death of spermatogenic epithelium. By the 2nd year of life, approximately 40-45% of undescended gonads are devoid of cells that perform the function of spermatogenesis. At the age of 3 years, about 30% of normally functioning tissue remains. By the age of 18, the testicles of a young man are completely devoid of spermatogenesis cells.
Possible complications of cryptorchidism:
- Infertility. As is known, the optimal temperature for the vital activity and functioning of the testicles is 33 ℃, while in the abdominal cavity and inguinal canal it is 4 ℃ and 2 выше higher, respectively. Under the influence of the temperature factor, the number of spermatogonia decreases and gland atrophy gradually develops.
- Hormonal disorders. The production of testosterone and other sex hormones is reduced, which also negatively affects the patient’s reproductive system.
- Malignancy (malignancy). In an ectopic testicle, the risk of a malignant tumor process in the gonads increases by a factor of 40-50.
- Inguinal hernia. When the testicles are delayed in the inguinal region, the risk of developing an inguinal hernia increases (in this case, the testicle will be the main contents of the hernial sac) and its infringement. This condition requires surgical intervention.
- With cryptorchidism, the likelihood of testicular injury is also increased.
- Torsion of the testicles. This complication is due to the high mobility of the dystopian male reproductive gland. With the development of torsion in the testicle, blood flow abruptly stops and tissue necrosis occurs.
Thus, if parents independently found in their child the absence of a testicle in the scrotum, it is recommended that you contact a pediatrician as soon as possible, who will refer you to a pediatric surgeon for differential diagnosis (with false cryptorchidism and other similar pathologies) and the selection of a treatment method.
You should not expect an “independent” prolapse of the glands by the 3-4th or even 7th years, since the longer the testicles are in an atypical place, the higher the likelihood of developing irreversible complications.
Terms and methods of treatment
Previously, many medical practitioners and researchers considered 6-7 years old the optimal age for the operation due to the greater maturity of the anatomical structures of the reproductive system, but now it is recommended that surgery be performed from 6 months of age and, preferably, up to 2 years. The change in the term is due to the fact that a pattern was revealed between the patient’s age and the degree of gonadal damage.
Surgical reduction of the testicles to the age of two allows you to avoid complications and maintain the basic functions of the sex glands.
Before surgery, the child must be performed ultrasound scanning of the scrotum and pelvis using color Doppler mapping. This helps to determine a more accurate location of the testicle, the degree of its defeat and the nature of the blood flow in it.
Non-palpable testicular syndrome (cryptorchidism) is a serious and quite dangerous pathology. It requires, as early as possible, seeking medical help in order to confirm the diagnosis and timely surgical removal of testicles.