Undescended Testes

In a male fetus, testes (the primary male gonads) are developed inside the abdominal cavity and before or right after the birth, these vital organs descends down into the scrotum. In some males, testes fails to descend completely and remains in the abdomen (or anywhere along the path between abdomen and scrotum). This condition is known as undescended testes or cryptorchidism. Sometimes, the testicular decent into the scrotum is completed by second to third month post-birth. However, if testes fail to descend completely by six months post-birth; then some sort of intervention is needed to minimize the risk of severe consequences.

What Are Some Classic Causes Of Undescended Testes?

Cryptorchidism occur more frequently in babies with hormonal imbalance. During prenatal period, lower levels of androgens i.e. male sex hormones are believed as a common risk factor that may lead to this condition.

Cryptorchidism can be unilateral (involving one-side only) or bilateral (both sides). It is more likely to occur in babies with medical conditions like Down’s syndrome, Klinefelter’s syndrome and other abnormalities like spina bifida.

Epidemiology Of Cryptorchidism

One out of the twenty newborns in the United States are born with undescended testes. By the age of six months this figure drops to one out of fifty because usually by this age testicular descent into scrotum is completed without any intervention. Though, in some countries this condition is becoming more prevalent.

Diagnosis Of Undescended Testes

Undescended testes can be diagnosed through physical examination. Sometimes the testes can be felt in the lower abdomen, but in most cases, empty scrotal pouch is suggestive of undescended testes.

What else should you know about undescended testes?

• Retractile testes: Retractile testes and undescended testes are two different conditions and should not be confused with each other. Sometimes the cremaster muscle i.e. muscle attached with testes, pulls the testes up into the groin due to which it cannot be felt or seen. Such condition is known as retractile testes. A retractile testes can remain high in scrotum for years but usually by the time of puberty it comes to its normal anatomical position. Any further treatment is not required if testes descend to scrotum and stays there. However, a healthcare professional must closely observe over time as there are chances that theses testes might become acquired undescended testes.

• Acquired undescended testes: Acquired undescended testes is a condition in which the testes lying inside the scrotum moves back into the groin. It is also known as acquired cryptorchidism and can happen from age one to ten years. It may happen because the spermatic cords (a cord that attaches testes to the body) does not grow at the same pace as rest of the body. As a result the short spermatic cords pull the testes back into the groin.
• Absent testes: An interruption in blood supply may cause the testes to die before birth. An absent testes can be linked with other birth defects of urinary system, for example abnormal network of blood vessels to the sperm carrying tubes i.e. vas deferens. In one out of twenty cases of undescended testes, there is a completely vanished testes.

Why Undescended Testes Requires Treatment?

If undescended testes remains untreated it may cause various health problems later in life.

1. Fertility:

Testes in abdomen can affect the sperm production because the temperature of scrotum is lower than over all body and the sperm producing tubes in testes works better at lower temperature. Fertility can be improved if testes is brought into the scrotum by age six to twelve months. However, men with bilateral undescended testes have very low quality sperms even after the surgery.

2. Trauma:

When testes are in abdomen, there is a greater chance of testicular injury or torsion i.e. twisting of testicles leading to interruption of blood supply (in untreated cases, it may lead to necrosis of testicular tissue within 6-8 hours).

3. Hernia:

Undescended testes are almost always associated with a hernial sac i.e. a lump which appears due to breakdown of tissue from the weakened area in wall of abdomen.

4. Testicular Cancer:

Men with undescended testes have ten times greater risk of developing testicular cancer.

5. Poor self-image:

An abnormality in testes can damage the confidence and pride of a boy because as boys grow older their body image becomes more important to them.

Treatment Of Undescended Testes

1. Orchidopexy:

This is the key surgical procedure to bring down the testes into the scrotum. Care should be taken while operating as there are chances of testes getting injured (which may culminate in removal of testes as the only option). Sometimes a second surgery is required if testes does not reach the scrotum after first surgery. One should wait six months after birth for the surgery as there are chances that the testes will come down on its own.

2. Hormonal injections:

These injections may work best if testes is very near to the scrotum. Human chorionic gonadotrophin (hCG) is the hormone that is usually injected. This hormone helps the testes to make male hormones and ease its descent into the scrotum.

Undescended Testes – FAQs:

1. What if an adult finds out that he has an undescended testis?

Usually undescended testes are removed in adults because bringing down the testes will not do any good for their fertility and if the men is above 40 then nothing is usually done.

2. Can it be prevented?

There is no such knowledge on how to prevent undescended testes.

3. Why must boys be told if they had undescended testes at birth?

Boys must know about their condition as later there maybe reproductive issues and chances of developing testicular cancer, for which regular testicular self-examination (TSE) is recommended.

References

1. Brakel, J., Kranse, R., Muinck Keizer‐Schrama, S. M. P. F., Hendriks, A. E. J., Jong, F. H., Bangma, C. H., ... & Dohle, G. R. (2013). Fertility potential in men with a history of congenital undescended testes: a long‐term follow‐up study. Andrology, 1(1), 100-108.

2. Plas, E. M., Brakel, J., Meij‐de Vries, A., Muinck Keizer‐Schrama, S. M. P. F., Hazebroek, F. W., Hack, W. W. M., & Dohle, G. R. (2015). Acquired undescended testes and fertility potential: is orchiopexy at diagnosis better than awaiting spontaneous descent?. Andrology, 3(4), 677-684.

3. Kurz, D., & Tasian, G. (2016). Current Management of Undescended Testes. Current Treatment Options in Pediatrics, 2(1), 43-51.