Symptoms and causes of cryptorchidism

"Cryptorchidism is defined as failure of one or both testes to descend into the scrotum, the skin sac containing the testes, located in between the perineum and the pubis," the 2 specialists explain. In 85% of cases, unilateral cryptorchidism occurs, and in the remaining 15% - bilateral cryptorchidism. 

"Normally, before birth, the testis descends from the abdominal cavity, through the inguinal canal, to the scrotum, where the testes then develop. In the scrotum there is a lower temperature than in the abdomen, ideal conditions for sperm maturation. In the case of cryptorchidism the migration of the testis from the abdominal cavity to the scrotum stops, this can happen at any level and at any time during this “journey”.”

Cryptorchidism, in most cases, does not give particular problems and does not show any signs of itself.

"There are rare complaints such as pain, fever, malaise, and a sense of bulging in the groin." 

The causes and risk factors that can lead to the occurrence of cryptorchidism are numerous and can be divided into:

• hormonal deficiency;
• mechanical: obstruction of the testis migration pathway from the abdominal cavity to the scrotum due, for example, to a closed inguinal canal, testicular blood vessels that are too short, or ductus deferens that is too short;
• genetic.

Premature birth, low birth weight, pollution, smoking and alcohol consumption during pregnancy are also considered risk factors.

Diagnosis, which is essentially clinical, occurs during the pediatric examination.

"If cryptorchidism is present, the scrotum is lacking one or both testes. It will be the pediatrician's job at that point to distinguish cryptorchidism from other conditions, such as anorchia (lack of testes) and ectopia (testis positioned in locations other than the migration route)," urologists continue. 

Once the abnormality is detected, it can be further investigated through certain examinations to identify the location of the testes: 

• ultrasound;
• magnetic resonance imaging;
• exploratory laparoscopic surgery, in the case of testicles retained in the abdominal cavity.

Experts warn: 

"Cryptorchidism should never be underestimated or neglected. If not treated in the recommended timeframe, it can cause:

• improper functioning of the testes;
• failure of seminal tissue development;
• progressive atrophy of the testis;
• poor or absent production of spermatozoids;
• low production of hormones (hypogonadism);
• possible, albeit rare, formation of an abnormal and/or cancerous mass in the testes."

In most cases of retained testicle, no treatment is needed because the testicles naturally move into the scrotum during the first few months of life.

"In about 75% of children with unilateral cryptorchidism, the retained testis tends to descend spontaneously into the scrotum by the age of 2," the experts confirmed. 

However, if the testicle does not descend spontaneously within the first year of life, it is necessary to visit the pediatrician so that cryptorchidism can be treated and corrected by the age of 2. 

"The most optimal treatment for cryptorchidism is surgical (orchidopexy) and aims to return and fix the retained testicle in its natural location (scrotum). The procedure is performed by making a small incision that will be closed with resorbable stitches. Normally, discharge is within the same day. 

It is important to emphasize that early intervention not only avoids potential complications in the future, but also makes surgery easier due to the anatomy of the child in this age group," Dr. Piccinelli and Dr. Galli conclude.