Cryptorchidism

Advanced and less invasive treatments

Cryptorchidism is a condition in which one or both testicles have not descended into the scrotum. Treatment is usually surgical, especially when the testicle does not descend spontaneously.

What is it?

Cryptorchidism , or undescended testicle, is a very common anomaly in pediatric males and is even more common in premature infants. It occurs when the testicle fails to descend into its normal position in the scrotal sac during pregnancy . It is identified by the absence of a scrotal sac on the affected side. In up to 30% of cases, cryptorchidism can affect both sides.

Cryptorchid testes can be divided into palpable or non-palpable , this classification being fundamental to deciding the treatment.

The palpable testicles are :

Maldescent of the testicle: are testicles that interrupted their path towards the scrotal sac and became trapped at some point along the path from the lumbar region, frequently remaining in the inguinal region.
Ectopic testicleThese are the testicles that are they deviated from their path during descent and are found in the femoral, pubic or perineal region.
Retractable testThese are testicles that have reached their normal position in the scrotal sac, but due to an exacerbated cremasteric reflex, They are inserted into the abdominal cavity during the physical examination..
Teste trapped: is the testicle that remained trapped in the scar of some surgical intervention in the inguinal region.

Non-palpable testicles are :

Intra-abdominal or canalicular testicle: in up to 50-60% of cases. Sometimes they are close to the deep inguinal ring and can protrude from the abdominal cavity into the inguinal canal.
Agenesis of the testicle: in up to 4% of cases. It occurs when one of the testicles did not form or it atrophied during pregnancy.

Symptom

In many cases, an undescended testicle does not cause symptoms or discomfort and is usually detected during a physical examination, when it is found that one or both testicles are not in the scrotum.

The most frequent signs are:

Absence of one or both testicles in the scrotum.
Scrotum with an empty or less developed appearance on one side.
Scrotal asymmetry.
In some cases, a palpable lump may be present in the groin when the testicle is located in the inguinal canal.

Causes

It occurs when the testicle does not reach its normal position in the scrotal sac during pregnancy.

Ectopic testicle : These are testicles that deviated from their path during descent and are found in the femoral, pubic or perineal region.

Agenesis of the testicle : occurs when one of the testicles did not form or atrophied during pregnancy.

Discovery

The medical history is very important in the diagnosis of cryptorchidism. It is important to know the mother's history of medication use (corticosteroids), any problems during pregnancy, family history of unexplained neonatal deaths, genital abnormalities, etc.

Additionally, an examination will be performed by a pediatric surgeon to rule out any associated abnormalities and to ensure that the cremasteric reflex, so exacerbated in some children, does not mask the true location of the testicle.

Imaging studies such as ultrasound are not usually necessary, as they have limited sensitivity in identifying ectopic testes, but they may be indicated in some patients to identify associated abnormalities.

Treatment

Currently, the treatment for cryptorchidism is surgical and is performed from 12-18 months of age so that the testicle develops normally, since the chances of spontaneous descent after that age are very small.

Depending on the location and whether or not it is a palpable testicle, the laparoscopic approach or an inguinal incision will be chosen.

Palpable testicles are accessed via the inguinal route. to close the connection with the abdominal cavity and fix the testicle in the scrotal sac. It is generally an outpatient procedure in which the patient goes home a few hours after surgery.
In patients undergoing laparoscopic surgeryThe surgeon will identify the testicle and the possibility of lowering it into the scrotum in a single procedure, or if, on the contrary, it is necessary to do it in two stages if the vessels that carry the blood supply to the testicle are very short and do not allow it.

During this procedure, the surgeon makes four incisions: one to insert the camera, two working trocars, and a scrotal incision to fix the testicle in the sac.

The hospital stay may be slightly longer for this type of procedure, but rarely more than one day.

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Dr. Laura Burgos Lucena

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