Cryptorchism (undescended testicle): how does it happen?
The testicles are a pair of oval-shaped, smooth, slightly tender male organs located in the scrotum behind the penis. It is normal for one to be larger than the other. The testes are the source of male sex cells – sperm – and function as an important endocrine gland, producing testosterone, the male sex hormone.
The testes develop during the boy's intrauterine development in the abdominal cavity and usually descend through the inguinal canal into the scrotum before birth. Boys are usually born with the testes correctly positioned in the scrotum. But this it is not always the case. About 3-4% of premature boys do not have descending testes after birth. The incidence of cryptorchism in premature boys is much higher, up to 30%, simply because they were born before the testes could take up their correct position during intrauterine development.
What are the risks of undescended testicles?
The testicles need a temperature of 34-35°C to function properly. Higher temperatures suppress sperm production and prolonged exposure to high temperatures can lead to permanent infertility. This issue is often discussed in relation to loose underwear for boys and men, as the scrotum and the testicles are less heated.
This is why the testicles are located outside the body in the scrotum – so that sperm production is not affected by excessive temperature. The body can correct their temperature to some extent by changing the tension of the scrotal wall. When the scrotal wall tightens, the testes come closer to the body where their temperature rises. When the wall relaxess, they move away from the body and the internal temperature drops.
"If the problem of an undescended testicle or testicles is not resolved, it is not only loss of fertility that threatens the future man. Undescended testicles are the biggest risk factor for testicular cancer, which most commonly affects boys and men between the ages of 15 and 35. The risk of cancer in an undescended testicle is up to 48 times higher than in a normal testicle. In the 15-35 age group, testicular cancer is the most common type of cancer," MUDr. Simona Zatkuliaková, the eveclinic urologist.
Retained – undescended testicle
There are several variants of this disorder in which the testicle cannot be felt in the scrotum: the testicle may be positioned in the abdominal cavity and not palpable on examination, or its descent may stop somewhere between the abdominal cavity and the scrotum. If it stops in the groin or an area above the scrotum, it is usually palpable. If the testicle is missing completely due to a damage during prenatal development, this is called anorchia.
Sometimes one of the testes is looser and more mobile than usual. The testicle can be felt in the scrotum, but more often it is in the inguinal canal rather than the scrotum. This condition is called testis mobilis, where the testicle can rotate on its axis, twisting the spermatic cord and subsequently restricting blood supply and outflow. This is an acute condition called torsion. If it is not treated quickly, the testicle will die within 4 - 6 hours. Therefore, if an excessively mobile testicle is diagnosed, orchiofixation is recommended as a precautionary measure. This involves attaching the testicle to the inner wall of the scrotum with a non-absorbable suture to prevent possible (or further) torsion. It is usually performed on both sides, i.e. both testes.
Undescended testes: treatment and its timing
The absence of one or both testicles in the scrotum is usually diagnosed by a neonatologist in the delivery room during the examination of the baby and reported to the paediatrician in a medical report. At the age of 3 months, the paediatrician performs a manual examination to see if both testes are present. In 75% of cases, the condition is corrected by this time. However, if the testicle is not correctly positioned in the scrotum at the age of 6 months, there is little hope that it will descend spontaneously into the scrotum. The boy will therefore be reffered to a paediatric endocrinologist, surgeon or urologist for an immediate diagnosis – the type of the cryptorchism and the exact location of the testis.
Depending on the findings, hormonal or surgical treatment will be selected. Treatment should be completed by the boy's second birthday to avoid compromising sperm production (sermatogenesis) and therefore adult fertility.
Before undescended testicle/testes surgery
During the consultation, which always precedes the operation, the surgeon will determine the position of the testes by palpation. Ultrasound or other imaging is not usually necessary.
The preoperative examination for general anaesthesia must be done at least 14 days before the operation. If the boy/man is healthy, without any congenital or chronic diseases, no blood test, X-ray examination or ECG is required.
Procedure of orchiopexy
Surgery of an undescended testicle or testicles is a relatively simple surgical procedure that does not require a long hospital stay or convalescence. It is carried out under general anaesthetics and, if the post-operative condition is unproblematic, the patient is discharged home the day after the operation.
The operation consists of releasing the testicle, repositioning it in the scrotum and securing it. The procedure varies depending on whether the testicle is palpable or non. If the testicle is palpable, we go straight to a surgery through a small incision in the groin area, with a small scar also on the scrotum. If the testicle is not palpable, a diagnostic laparoscopy must first be performed to determine the exact location of the testicle. Standard surgery will then be performed depending on the condition found. In exceptional cases, where one or both testes are located high in the body, the operation can be divided into two separate operations.
In the case of congenital cryptorchism, the operation of the undescended testis is recommended after the boy's first birthday, i.e. 12 to 18 months. In acquired cryptorchism, orchiopexy should be performed as soon as possible after the diagnosis is made.
Pain following orchiopexy
Shortly after a surgery, the wound is sensitive and painkillers (analgesics) are recommended for the first day. After that, the wound usually heals without problems or pain. Two wounds are made during the operation: one in the groin and one in the scrotum. The stitches do not need to be removed, as the sutures is absorbable and will resorb spontaneously within 2 or 3 weeks.
Orchiopexy – Recovery and aftercare
Normal daily activities without much physical exertion are possible on the second day after the operartion. Children do not need to stay in bed; they can usually play and walk from the second week. Good hygiene is important – avoid bathing, only shower only during recovery. There are usually no complications and the scars are usually very small.
Price of orchiopexy – operation or undescended testes
The price of orchiopexy in our clinic is given in the price list. The cost of the procedure includes the cost of general anaesthesia. Pre-operative examinations and consultations are not included in the price of the procedure.
