CRYPTORCHIDISM

Course overview

CRYPTORCHIDISM IS THE ABSENCE OF AT LEAST ONE TESTICLE FROM THE SCROTUM. IT IS THE MOST COMMON BIRTH DEFECT INVOLVING THE MALE GENITALIA. ABOUT 3% OF FULL-TERM AND 30% OF PREMATURE MALE INFANTS ARE BORN WITH ONE OR BOTH TESTICLES UNDESCENDED. APPROXIMATELY 80% OF CRYPTORCHID TESTES DESCEND BY THE THIRD MONTH OF LIFE. THIS MAKES THE TRUE INCIDENCE AROUND 1%. CRYPTORCHIDISM MAY OCCUR ON ONE OR BOTH SIDES BUT MORE COMMONLY AFFECTS THE RIGHT TESTICLE. THE TESTICLE MAY BE ANYWHERE ALONG THE "PATH OF DESCENT," SUCH AS: LOCATED HIGH IN THE RETROPERITONEAL ABDOMEN TO THE INGUINAL RING; IN THE INGUINAL CANAL; ECTOPIC FROM THE PATH OF DESCENT; HYPOPLASTIC; DYSGENETIC; MISSING OR ABSENT; UNILATERAL (TWO-THIRDS). THE UNDESCENDED TESTICLE CAN USUALLY BE PALPATED IN THE INGUINAL CANAL. IN A MINORITY OF PATIENTS, THE MISSING TESTICLE MAY BE LOCATED IN THE ABDOMEN OR BE NONEXISTENT. UNDESCENDED TESTICLES ARE ASSOCIATED WITH DECREASED FERTILITY (BILATERAL CASES), INCREASED TESTICULAR GERM CELL TUMORS (OVERALL RISK UNDER 1%), TESTICULAR TORSION, INGUINAL HERNIAS, AND PSYCHOLOGICAL PROBLEMS. WITHOUT SURGICAL CORRECTION, AN UNDESCENDED TESTICLE MAY DESCEND DURING THE FIRST THREE MONTHS OF LIFE. UNDESCENDED TESTES MAY BE BROUGHT INTO THE SCROTUM WITH AN ORCHIOPEXY TO REDUCE RISKS. CRYPTORCHIDISM, HYPOSPADIAS, TESTICULAR CANCER, AND POOR SEMEN QUALITY MAKE UP TESTICULAR DYSGENESIS SYNDROME (TDS). THIS SYNDROME IS THOUGHT TO BE DUE TO HARMFUL ENVIRONMENTAL FACTORS THAT DISRUPT EMBRYONAL PROGRAMMING AND GONADAL DEVELOPMENT DURING FETAL LIFE. THIS ACTIVITY REVIEWS THE WORKUP OF CRYPTORCHIDISM AND DESCRIBES THE ROLE OF HEALTH PROFESSIONALS WORKING TOGETHER TO MANAGE THIS CONDITION.