Undescended testes (cryptorchidism) in children

What is it?

Cryptorchidism means “hidden testicle”.

The testicle is arisen below the kidney. Then it goes down the abdominal cavity to the inguinal area and enters the scrotum in the seventh month of pregnancy.

This is the absence of one or both testicles in the scrotum.

If the testicle remains outside the scrotal sac after the age of two years, irreversible structural damage can occur, which can jeopardize the future fertility of the person. Boys who still have an uncorrected cryptorchidism at age 15 or older have an increased risk of developing testicular cancer.

Causes and risk factors

Cryptorchidism can be congenital or caused by the testicles not descending into the scrotal sac. There is still no consensus on the causes of this condition. There are two main hypotheses:

·      mechanical obstruction hypothesis: an anatomical obstruction of the testicle prevents it from descending into the scrotum;

·      endocrinological hypothesis: there is a hormonal deficiency or, in any case, the hormonal action is reduced, so that the descending testicle is not stimulated.

Which are the symptoms?

Cryptorchidism is not accompanied by pain, the child does not complain, and only observation by the parents or doctor reveals the absence of a testicle in the scrotum.

A specialized examination by a pediatric surgeon or pediatric urologist can determine if the testicle is in the scrotum or if it is palpable at the level of the inguinal canal. Additional examinations, such as an abdominal ultrasound, are not helpful in making the diagnosis. In fact, the testicle is palpated already during the examination, and if it is present in more hidden areas, it cannot be recognized even by instrumental examination.

How is it diagnosed?

In the case of an unpalpable testicle, exploratory laparoscopy is performed to determine the absence or presence of a testicle in the abdominal cavity. This examination is performed under general anesthesia and allows accurate assessment of the internal anatomy by a small camera inserted into the abdominal cavity from the navel.

How is it treated?

Spontaneous descent of the testicle can occur before the age of 18 months. Therefore, wait until this age before proceeding with any treatment.

The least invasive treatment option, done as an outpatient or at home, is hormone therapy. Hormone therapy is based on the administration of low doses of male hormones that act only on the testicles and have no side effects. However, it is effective in a small number of cases.

At the age of two, if the testicle has not descended into the scrotum spontaneously or as a result of medical treatment, corrective surgery is recommended to prevent problems with infertility in adulthood. Open orchidopexy involves an incision in the groin, freeing the spermatic cord from anything that might interfere with the descending testicle, and placing the testicle in the scrotum, paying maximum attention to vascularization.

The duration of surgery varies from 20 minutes to 1 hour and requires a short hospital or day hospital stay.

Laparoscopic orchidopexy, on the other hand, involves two or three small incisions in the abdomen to install a small camera and the necessary instruments: this way, internal anatomical structures are visualized and large skin incisions are avoided. The procedure is similar to an open orchidectomy, but lasts about 30 minutes and requires an overnight stay.

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