What is cryptorchidism? An authoritative doctor explains!

Cryptorchidism is a disease in which male friends have incomplete descent or ectopic testicles. Although many cryptorchidism patients cannot see their testicles, they can be felt. However, a small number of cryptorchidism patients not only cannot see their testicles, but also cannot feel them. Some will also have testicular atrophy. In short, the harm of cryptorchidism is very serious. The following is an introduction to the relevant professional knowledge of this disease.

1. What is cryptorchidism?

Cryptidysis refers to the failure of the testicles to descend into the scrotum. It includes incomplete testicular descent and ectopic testicles. Clinically, the vast majority of cryptidysis is incomplete testicular descent. Ectopic testicles are most often located in the superficial fossa of the inguinal groove. 80% of cryptidysis can be palpated, 20% cannot be palpated, about 20% of the inpalpable testicles are absent testicles, and 30% are testicular atrophy. Children can retract their testicles, and usually only follow-up visits are required to prove that the testicles are in a normal state and not retracted. When diagnosing bilateral anorchiasis, the male chromosome karyotype must be confirmed and an endocrinological evaluation is necessary to help determine whether unilateral or bilateral testes are present.

2. Clinical manifestations

1. Infertility

Cryptidysty can cause damage to reproductive cells. Early surgical treatment is needed to fix the testicles to the scrotum to reduce the risk of reduced fertility. The earliest postnatal histological abnormality of cryptidysty is the dysplasia of interstitial cells that can be observed in the first month after birth. Unilateral cryptidysty after puberty should be removed because it is prone to malignant and torsional changes in the future, and most testicles have lost their fertility.

2. Malignant change

Children born with undescended testicles are at risk for testicular malignancy. The incidence of germ cell tumors in men with a history of occult testes is about 40 times higher than in the normal population. The location of the undescended testicles affects the relative risk of testicular tumors, with the higher the location, the greater the risk of malignancy. Half of the intra-abdominal testes will develop malignancy. The most common type of testicular tumor arising from the testicles is a seminoma. The incidence of carcinoma in situ in men with occult testes is 1.7%.

3. Hernia

90% of patients with undescended testes have a patent processus vaginalis. The processus vaginalis usually closes after testicular descent and within the first month after birth. A patent processus vaginalis is associated with a higher risk of epididymal abnormalities. The clinical significance of a patent processus vaginalis is that it can affect the efficacy of hormonal treatment for cryptic testis.

4. Testicular torsion

Cryptotestis may have abnormal attachment of the gubernaculum, levator testis, or tunica vaginalis, which predisposes to testicular torsion. Although undescended testicles rarely torsion, testicular torsion should be considered in patients with abdominal or groin pain accompanied by lateral scrotal hollowness.

3. Causes

Cryptorchidism is caused by abnormal testicular descent. There are many factors that cause abnormal testicular descent, the most common of which are:

1. The gubernaculum testis, which guides the testicles into the scrotum, is abnormal or absent, so that the testicles cannot descend from their original position into the scrotum.

2. Congenital testicular dysplasia makes the testicles insensitive to gonadotropin and loses the power to descend.

3. The luteinizing hormone released by the hypothalamus causes a lack of LH and follicle stimulating hormone (FSH) secreted by the pituitary gland, which can also affect the power of testicular descent. Those caused by endocrine factors are mostly bilateral cryptic testis, while those caused by other factors are mostly unilateral cryptic testis. Sometimes cryptic testis can be combined with inguinal oblique hernia.