Undescended testicles treatment
Undescended testicles (so-called cryptorchidism) are a congenital disorder when the testis is not moving to the scrotum. Most often, it is diagnosed in newborn children or before adolescence. The treatment goal is to restore the normal position of the testicle. Physicians use watchful waiting and hormones, but the most effective treatment is surgery.
Testicles during fetal development have not migrated to the scrotum. An undescended testicle is a problem observed in newborns due to the absence of one or both testicles in the child's scrotum. It occurs due to a violation of the natural process of moving the testicles into the scrotum, usually in the seventh month of pregnancy.
With an undescended testicle, at least one testicle is not in its natural position in the scrotum but the groin or lower abdomen. In most cases, this is a congenital disorder noticeable at birth. Only in rare cases the testicle firstly is in the correct position and then rises. Then, doctors talk about a secondary undescended testicle.
Testicles fall into the boy's scrotum during the foetal period or immediately before childbirth. So it becomes clear that undescended testicles are more common in premature boys because they do not have time to reach the required place. Such a disease is also called cryptorchidism.
Statistics give such data on undescended testicles:
- in approximately four babies out of 100, the testicles do not drop down until the moment of birth;
- in 3 out of 100, they descend into the scrotum during the first six months of life;
- in 1 out of 100 babies, it does not happen at all;
- up to 85% of cases of undescended testicles in boys are one-sided.
Undescended testicles increase the risk of developing severe complications in adult men: testicular torsion, inguinal hernia, infertility, and testicular cancer.
What is the cause of cryptorchidism?
Doctors have not yet established the exact causes of undescended testicles. However, certain factors can influence disease development:
- Premature birth;
- The testicle is underdeveloped;
- Weakness of the muscles involved in the testicle movement;
- Overgrown connective tissue blocks the path of the testicle;
- Hormonal changes in the mother and fetus;
- Diabetes mellitus or thyroid disease in the mother;
- Smoking during pregnancy.
Chromosomal changes and infections during pregnancy (influenza, toxoplasmosis, rubella) are among the most provocative factors in undescended testicle development.
The signs of the disease
The main symptoms of cryptorchidism are the absence of one or both testicles in the scrotum. Instead, the doctor may feel the testicle in the groin or perineum. In this case, the patient may experience pulling pains in the lower abdomen. In addition, the child begins to cry and becomes restless.
With both-sided undescended testicles, the symptoms are associated with feminisation. It means increasing female hormones and some women signs:
- Breast enlargement;
- Wide pelvis;
- High voice.
Undescended testicles in children cause the development of many unfavourable disorders:
- Severe inflammation;
- Oppression of the testicle;
- Limited movement and walking;
- Twisting of the spermatic cord.
As patients grow older, other symptoms of the disease appear. So, up to 30% of male infertility cases are associated with undescended testicles. If a testicle is not in the scrotum, sperm cannot mature properly. As a result, the number of spermatozoa and their ability to fertilise is much less.
In addition to problems with spermatozoa maturation, high temperatures in undescended testicles increase the risk of cell malignancy, causing testicular cancer.
What is the diagnostic process?
To diagnose an undescended testicle, the doctor palpates the scrotum of the newborn. If the testicle is not palpable, a pediatric urologist performs additional imaging methods to determine the location of the testicle:
- Ultrasound of the abdomen and pelvis shows the location and size of the testicles, as well as their possible changes.
- MRI or CT scan of the abdomen and pelvis allows doctors to get a layer-by-layer image and evaluate the location, condition of the testicles and blood flow.
- Laparoscopy makes it possible to find the testicle, estimate its condition, and determine the development of blood vessels and ducts. The urologist inserts a tiny tube with a camera through a small incision in the abdomen. The method helps to decide on the treatment method. If necessary, the doctor may also perform corrective surgery during the examination.
If both testicles do not descend, the doctor may recommend a genetic test to determine the sex chromosomes and a blood test to measure hormone levels.
Treatment methods for undescended testicles
For the first six months, doctors use a waiting tactic. In about half of all babies with cryptorchidism, the testis descends on its own within three months of birth.
If by the age of 6 months, the testicle has not descended, treatment by a pediatric urologist is required. After that, doctors perform conservative (drugs) or surgical treatment.
Hormonal drug therapy can be effective because moving the testicle to the scrotum is hormone-dependent. The success of such treatment is more or less good. Half of the children achieve a positive effect. However, the higher the testicle is located, the lower the effectiveness of such therapy.
Surgical treatment consists of the operational descent of the testicle into the scrotum (orchiopexy). The child usually undergoes this operation between 6 and 18 months. The choice of surgery depends on where the testicles are located. The surgeon may perform a laparoscopic or open operation. If the organ dies due to twisting or pinching, the surgeon removes the testicle (orchiectomy). The chances of success in the surgical treatment of undescended testicles are much more significant than in hormone therapy.
Physicians also might recommend testicular prostheses to correct the aesthetic appearance and save a man from complexes. They are implanted in late childhood or adolescence.
About 50% of boys have testicles that descend independently during the first six months of life without any treatment.
The surgical procedure to fix undescended testicles is about 98% effective. Therefore, such men have an excellent opportunity to have children. In addition, the risk of developing testicular cancer due to cryptorchidism is less than 1%.
What is the best treatment for cryptorchidism?
The primary method of treating cryptorchidism is an operation to move the testicle into the scrotum (orchidopexy). This operation is almost 100% successful. However, the surgeon operates within the year if the testicle has not fully descended by six months.
Is cryptorchidism surgery possible in adults?
Orchidopexy is possible in rare cases for adults. But such an operation in adulthood has a rather cosmetic purpose, but there is no chance of restoring the fertility function. Therefore, it is best to operate before the age of 2.
How to find a clinic for undescended testicles?
Since the disease requires surgical intervention in children, parents often prefer quality treatment abroad. Therefore, AiroMedical cooperates with leading clinics worldwide. Our patient manager will help you choose the most optimal clinic and an experienced surgeon, considering all your needs.
Are undescended testicles dangerous?
Yes. Delaying treatment increases the risk of infertility later in life. In addition, boys with undescended testicles have an increased risk of testicular tumours and cancer. Another possible danger is the torsion of the undescended testicle.
What doctor is responsible for cryptorchidism treatment?
A paediatrician and a paediatric urologist identify the disease in a child and define the necessary diagnosis and treatment.
Where can I get Undescended testicles treatment?
What are the best clinics for Undescended testicles treatment?
Who are the best doctors for Undescended testicles?
Prof. Dr. med. Jurgen Gschwend from University Hospital rechts der Isar Munich
Prof. Dr. Torremade Barreda Josep from Teknon Medical Centre Barcelona
Dr. Luis Garcia Aparicio from Teknon Medical Centre Barcelona
Prof. Dr. med. Martin Kriegmair from Urological Clinic Munich-Planegg
Prof. Dr. med. Laszlo Kovacs from Urological Clinic Munich-Planegg