Definition: what is cryptorchidism?
word cryptorchidia comes from the Greek “kryptos” meaning “hidden” and “orkhis” meaning “testicles”. Usually during fetal lifethe testicles migrate out of the lumbar region to the scrotum. But it happens that one or both testicles do not descend into the pouches during the development of the male genitals: we then speak of cryptorchidia. “There are several clinical pictures,” explains Dr. Christopher Lopez. The testicle may be palpable at the level of the groin or pubic fold, or not palpable in the abdomen.”
this testicular migration abnormality touched nearby 3% of little boys at birth. A value that drops to 1% at the age of one year, the testicles can still migrate in the first year of life of the child. Cryptorchidism would be a concern 20-30% of premature babies.
Cryptorchidia vs. ectopia testiculaire
If the cryptorchidia refers to the stopping of the testicle’s migration along its normal path between the lumbar region, where it forms, and the scrotum, whichtesticular ectopia denotes again Migration of a testicle from its normal course : i.e. in the perineal, femoral or even prepenile area (in the middle of the abdomen between the navel and the penis).
Why does one or both testicles sometimes not sink into the bursa?
With the little boy who migration of the testicles from abdomen to scrotum takes place during the last trimester of pregnancy. However, it happens that a birth defect impedes this migration and that one of the testicles (or both) remains in the abdomen or at the level of the groin fold. This positional defect of the testicle then requires early surgical care due to its position Effects on fertility And you tumor risk (testicular cancer).
At what age do the testicles descend?
Usually, the testicles migrate from lumbar region to the scrotumduring fetal lifeduring the third trimester of pregnancy. But it happens that migration does not end with birth and occurs spontaneously during childbirth first year of life Of the child.
That’s why we mustn’t rush anything, the specialist reassures us. However, if the testicle has not descended after 18 months of age, then it is good to solve the problem.
What is the baby’s diagnosis?
The diagnosis is mainly clinical. “Often we notice a bursa hypoplasia That means they’re smaller, a sign that one or both testicles haven’t descended, explains Dr. Christopher Lopez. And to add: “Be careful not to get confused cryptorchidia with the “testicle lift”. Indeed, it happens that on auscultation the Muscle Cremaster Pull the testicle up the inguinal canal. Sometimes just putting your hand on your thigh is enough to make it happen! The testicle then descends when the child is relaxed. That’s why I advise parents to examine their little boy when he calmly comes out of the bath or shower. If the testicle is present in the bursa, there is nothing to worry about. Otherwise it is like this necessary to seek the opinion of a doctor ».
Bilateral or Unilateral Cryptorchidism?
However, if the cryptorchidism is mostly unilateral (80% of cases), it can be bilateral, that is, the two testicles are missing from the scrotum (20%).
What causes cryptorchidism?
The cryptorchidia can be attributed to several causes:
– a mechanical barrier to migration : for example, an inguinal canal that is too narrow, abnormal adhesion of the fetal testicle to the retroperitoneal tissue, fibrous obstruction of the testicular opening, etc.
– a hormonal problem : Insufficient production of male hormones or significant exposure to female hormones (estrogen) during pregnancy may explain why the testicle does not migrate to the bursa.
– a genetic abnormality : for example the Prune Belly Syndrome is often associated with bilateral cryptorchidism.
What are the risk factors?
– a familial predisposition : Studies have shown that a child whose father had a testicular migration abnormality has a greater risk (4.5%) of developing this problem.
– that prematurity or one low birth weight : Between 20% and 30% of preterm infants may have a migratory defect in one or both testicles. Extremely premature babies are also more affected by this disease.
What are the consequences of cryptorchidism?
Effects on fertility
The cryptorchidia can have harmful effects on the male fertility. In order for the sperm to develop under good conditions, the temperature of the testicles must be around 35.5 °C. Therefore, it is important that they are positioned in the bursae (the scrotum) outside of the body. “The risk of infertility increases to 5% with unilateral cryptorchidism, specifies the location of the health insurance company. He can reach 50% if bilateral. Surgical treatment reduces this risk by half.”
The cryptorchidia is one of the main risk factors for testicular cancer. “In young men whose testicles did not descend before the age of six, the risk of developing testicular cancer is about 35 times higher, specifies the Foundation for Cancer Research. However, this figure should be put into perspective when we know that only 6% of testicular cancer cases occur in men affected by this anomaly.” Surgery in childhood does not completely protect against later risk of cancer, but it does facilitates monitoring since the Testicles are made palpable…
What is the treatment?
that Treatment of cryptorchidism is only surgical. “In the simple forms, when the testicle is palpable, the operation is usually performed in outpatient under General anesthesia. The child comes back in the morning and leaves in the afternoon. The surgical procedure (orchidopexy) consists of freeing the testicle from its appendages, lowering it into the bursa and fixing it there, explains Dr. Lopez. On the other hand, in the heavier forms – ie if the testicle cannot be felt and positioned in the abdomen – often two laparoscopic operations are necessary after 6 or 12 months Intervals to lower the testicle and preserve its vascularity. If during surgery it turns out that the testicle is atrophied or poorly vascularized, the surgeon will likely remove it (this is called an orchiectomy). This is in fact useless and can be the cause of later complications.
What are the operational consequences?
The postoperative course is general little painful and easily relieved by taking painkillers of the paracetamol type. The urologist, on the other hand, advises avoiding sports and swimming pools for a month.