Undescended testicles

The undescended testicle (undescended testis, cryptorchidism) is the most common anomaly of the urogenital tract and occurs in approximately 4% of boys born on time and because it is a developmental disorder, even more common in premature babies before. Undescended testicles are at one or both testicles at birth is not in the scrotum.
During the prenatal development of the testes normally migrate from the abdomen through the inguinal canal into the scrotum. In an undescended testicle of the localization differs from the norm. Providing they have been applied, when the testicles are undescended testicles somewhere on the path between the system and destination. Cause of undescended testis may be anatomical features of the spermatic cord or the inguinal canal, hormonal disruptions from the mother and the child, possibly a genetic predisposition. Depending on the location of the testes different forms can be distinguished.

    Pendulum testicles
    Testes testicles the pendulum changes its position between the inguinal canal and scrotum. Upon cooling, or mechanical irritation, he is pulled up by muscle pull. It can be pulled down without tension.

    Same Thoden
    When sliding Thoden the testicles can pull down the inguinal canal into the scrotum, but immediately slips back again because of the spermatic cord is too short.

    Inguinal testes
    When inguinal testes, the testes in the inguinal canal does not feel, however, move into the scrotum.

    Abdominal testis
    In the abdominal testes, the testicles are still in the abdomen.

    Lack of testicular system (anorchia)
    It may also happen that the testicles are missing altogether, because they were not created as an organ (agenesis).

In the majority of cases, the undescended testes palpable in the inguinal canal, only about 8% of the cases he is still in the abdomen.

Time of diagnosis, age of child, location of the testicles and cause of undescended testis decide on treatment. This should be up to the age of 18 months to be completed in order to avoid the risk of consequential damage.

Diagnosis

As part of the screening tests, your pediatrician will regularly monitor the position of the testicles. You should occasionally during winding but also self assess whether both testicles are descended into the scrotum. When the right undescended testis is palpable and often affected in four out of five patients in the inguinal canal. Since this is a developmental disorder, there is a good chance that the testicle to the end of the first year of life nor descends into the scrotum.

The best time for investigation is prior to 6 Month because of Hodenhochzugreflex (cremasteric) still is not very pronounced and allow the flab a thorough investigation yet. In this palpable testicles, the doctor will gently streak with the fingers of one hand from the inguinal canal down and touch her with his other hand from the scrotum against it. It may distinguish bars, sliding and swing balls. This examination is performed several times within a few weeks, because the situation may change due to a delay in testicular hike yet.

One testicle is not palpable, with the help of ultrasound can be in the majority of cases to determine the precise location in the abdomen. Should this fail, further investigations are required.
To make the situation of an abdominal testis identified as magnetic resonance imaging or computed tomography is not always suitable, because abdominal testes are malnourished and often very small. It is usual in such cases the laparoscopy (laparoscopy). This can be determined where the testicles are located and in which nutritional status is or whether he is missing and has not been created. In the same session will receive the needed therapy to be performed.

Both testicles should not be palpable, it is tested with a hormone stimulation test whether any testicular tissue is present. This is the case if the stimulation of testosterone levels in the child increases. In any case, a laparoscopy is done to determine the position of the abdominal testes and possibly even to undertake operational steps to prevent future damages.

Consequential damages

The earlier the treatment begins with an undescended testicle and is successful, the lower the resulting damage will be. Only through early diagnosis and treatment of testicular damage and infertility may be avoided. A therapy should be up to the second Years to be completed.

Infertility:
It is well known that the testes need for the production of sperm cells, a temperature of 32 to 37 degrees Celsius. Therefore, the testicles are outside the body. When the undescended testicle is not the case and the higher body temperature means that the primordial germ cells (Gonocyten) can not develop into the seed germ cells (spermatocytes). The result is a lack of seed production, which leads to infertility. The number of primordial germ cells increases to 3 Age rapidly. Therefore, a therapy to 18 Months to be completed.
With unilateral cryptorchidism the incidence of infertility is similar to the rest of the population.
Almost all patients not treated with bilateral undescended testes are infertile, even after treatment, there are still two-thirds.
(See also: Make sterile disposable diapers?)

Testicular cancer:
Testicular cancer has an incidence of 1% of cancers in men rather rare. It is suspected link with a low sperm count. But the risk of developing it is 20 - to 40-fold increased when one undescended testicle or was not treated too late. The highest risk have this abdominal testes and testicles get stuck in inappropriate places (Hodenektopie). In 60% of the cases developed a seminoma in the age between 20 and 40 years. The prognosis and thus the chances of healing are at an early discovery of the tumor very well.

Testicular torsion:
Testicular torsion is a rotation of the helical bundle spermatic cord and the testicle around its longitudinal axis. This abnormal mobility is increased above with undescended testicles or late descended testicles.

Inguinal hernia:
When undescended testicles, there is always an open inguinal canal. He closes himself until after the testicle is moved into the scrotum. In surgical treatment of undescended testes of these innate, childlike hernia is always supplied. Recurrence (Rezidivhernie) is rare after this operation.

Therapy

The undescended testicle is increasingly seen as a hormonal disorder involving their treatment needs more than just the purely anatomical correction by shifting the testes into the scrotum. What treatment should be initiated in a particular case may decide only the treating physician who examined the child and has observed the course. His decision depends on the time of diagnosis, age of child, location of the testes and other anatomical changes (eg hernia).

Must be treated at all ...
... or a random shift of the testis in the scrotum is possible? In most cases (98%), the testicles move spontaneously by the end of the first year of life in the scrotum. Longer you should be on this late testicular descent not wait, because only the early treatment can prevent subsequent damage. This was before 15 to 18 Months to be completed.

When is the treatment?
Temporal goal is the correct localization of both testicles at the latest by 2 Birthday of the child, with the trend is moving downwards and the treatment goal since the 15th Month of life is. This is because the number of sperm precursor cells from the end of the first year and gradually decreased fertility is then more difficult to obtain.
A special case here testicles the pendulum, in which there is only a need for treatment if the testicle lies mainly in the inguinal canal.

What treatments are available?
In principle, there is the possibility of hormone therapy and surgery. It should lead to further remember that only 4% have a birth date of undescended testicles. Only 2% of these affected children must eventually be treated. Hormone therapy is very important because it is understood as hormone replacement therapy.

Hormone Therapy
With unilateral or bilateral with palpable undescended testis is detectable by ultrasound or hormone treatment carried out. The hormone HCG (human chorionic gonadotropin) is no longer used because he has shown an increased mortality rate among the primordial sperm cells (spermatogonia) and testicular shrinkage. GnRH (gonadotropin releasing hormone) acts on a higher level and stimulates the release of testosterone, which triggers the migration of the testicle and causes the stimulation and improvement in sperm count and sperm maturation. GnRH is administered as a nasal spray. The therapy takes place according to different schemes. The early, hormone treatment before surgery were significantly more detectable sperm precursor cells. Because of possible relapses regular follow-up examinations are required.

Operation
For non-palpable testis on one side without evidence on ultrasound but healthy counterpart, is an operation made by the bar. In 2 / 3 of cases there is only the spermatic cord bundle. The testicle is often stunted and will be removed to prevent subsequent damage. In other cases, the testicle is freed from adhesions and stitched at the lowest point of the scrotum.
When both sides non-palpable testis without evidence on ultrasound a laparoscopy is done. In 50% of cases the testicles can be obtained.