- What is Cryptorchidism?
- What is the cause of Cryptorchidism?
- What is the treatment of Cryptorchidism?
What is Cryptorchidism?
Cryptorchidism is a congenital abnormality when the testis or testes do not follow the normal descending course from the abdomen -where they are located until the 7th month of gestation- down to the scrotum. This may occur to either one testis or both testes, in about 2-5% of newborn boys and is related to gestational age (it is more common in premature boys). The incidence rate reduces after birth, as long as testes descend to their normal position; thus, the incidence rate after the age of 3 months old gets particularly limited.
What is the cause of Cryptorchidism?
The aetiology is complex and involves disorder of the fetal endocrine system in combination with some gene abnormalities; this is the so-called Testicular Dysgenesis Syndrome. Besides cryptorchidism, children with this syndrome seem to demonstrate higher infertility rate and risk for developing testicular cancer. That is why the annual check-up by the Urologist is imperative, even after restoration of cryptorchidism.
What is the treatment of Cryptorchidism?
Some hormones used to be widely used in the past during neonatal age, in order to help testes descend, even though after its discontinuation there was recurrence in 1/5 of the cases. However, it was found that the administration of these specific hormones could be harmful for spermatogenesis. Therefore, hormonal therapy is not recommended today as treatment for cyrptorchidism.
The success rate of surgery amounts to 70-90%. Once the testes are localized, the physician will immobilize and fixate them on the scrotum. Of course, this is done when the testis is in a position from where it can descend. If it is localizeded in the abdomen and has atrophied, it is removed, for it is highly likely to cause cancer. Lastly, if functional, it is displaced subcutaneously (under the skin), so that it can be easily monitored postoperatively.
There is still a lot of discussion about which is the best age indicated for surgery. However, it seems that it should be done during the two first years of life, for this has beneficial effect on the future maintenance of fertility. If surgery is performed in adulthood, the testis -even atrophic- must be retained because it continues producing testosterone. Yet, biopsy is recommended, for there may be some precancerous lesions. The most severe postoperative complication that might occur is gradual testicular atrophy. In such cases, semen should be frozen and stored for future use, before the testis becomes fully atrophic.