Cryptorchidism in children

A condition known as cryptorchidism, or undescended testicles, affects some newborn boys. Most of the time, the testicles descend into the scrotum naturally before birth. However, instead of descending as they should, one or both testicles remain in the abdomen or groin area in children with cryptorchidism.

Although full-term babies can also develop this condition, premature babies are more likely to do so. Parents may worry about cryptorchidism, but the good news is that it usually goes away on its own during the first few months of life. In the event that the testicles do not descend naturally, medical intervention might be required.

Since untreated cryptorchidism can impair fertility and raise the risk of other complications, early detection and treatment are crucial. During routine check-ups, parents should see a doctor if they notice any problems with their child’s testicles.

Topic	Details
What is Cryptorchidism?	Cryptorchidism is when a child"s testicle does not descend into the scrotum at birth.
Why does it happen?	It usually occurs because the testicle stops moving down during development.
Is it common?	Yes, it affects about 1 in 100 boys, especially those born prematurely.
How is it treated?	Many times, the testicle descends on its own by the first year. If not, surgery may be needed.
Can it cause problems?	If untreated, it may affect fertility or increase the risk of testicular cancer later in life.

What is it

The inability of the testicles to descend into the scrotum is known as cryptorchidism. In this instance, the testicle may be found in the peritoneum or groin region, primarily in the inguinal canal, or it may be found in close proximity to its normal location. Occasionally, boys’ sex glands "deviate from the course" and exit the inguinal canal, staying subcutaneous in the pubis, thigh, and perineum instead.

In healthy, full-term babies, this type of congenital pathology is found in only 3-4% of cases. Nonetheless, the prevalence of cryptorchidism rises to 25–30% in premature babies.

A baby born very prematurely weighing less than 1 kilogram at birth will almost certainly be diagnosed with cryptorchidism, according to medical professionals. The "lost" testicle is palpable through the skin in over half of the cases. Sometimes, though, this is not possible due to a congenital developmental anomaly where the child is born without one or both sex glands.

Causes and mechanism of occurrence

It’s important to understand that male embryos are always temporarily cryptorchidistic. To put it another way, boys’ testicles do not develop in the scrotum.

They are deposited and develop considerably higher—in the kidney region of the abdominal cavity. The sex glands, which will eventually be responsible for many of the most significant tasks performed by men, depart for their natural habitat at the eighteenth week of pregnancy. They start to smoothly and gradually descend to the scrotum, going lower and lower. They typically descend from the pelvis to the scrotum between weeks 28 and 30 of pregnancy. But things aren’t always like this. Any prolapse that happens before delivery and during the first six weeks of the baby’s independent life is considered normal.

The testicle does not set off on its own, it is set in motion by a special cord consisting of connective tissue. It connects the sex gland to the scrotum. At the right moment (by the middle of the second trimester of pregnancy), the cord contracts sharply. The movement of the testicle is facilitated by an increase in intra-abdominal pressure, contraction of the intestines and the work of the appendages of the sex gland. If a failure occurs in one of these links, the testicle goes to the wrong place. Most often, it simply stops moving and remains in the abdominal cavity, but sometimes it migrates subcutaneously to any part of the groin area.

According to medical opinion, the weakness of the peritoneum is the primary cause of cryptorchidism, which explains why pathology affects newborns far more frequently than older children.

• Genetic diseases. Cryptorchidism often accompanies Down syndrome, Noonan syndrome, and also occurs in children with mutations of certain genes responsible for the correct formation of sex. Chromosomal abnormalities can also be caused by the negative effects of toxic chemicals.
• Hormonal imbalance. If the baby"s body does not have enough sex hormones that ensure the advancement of the testicle or it is more strongly influenced by maternal estrogen, then insensitivity or testosterone deficiency develops. The lack of this hormone slows down or does not start the process of lowering the sex glands into the scrotum.
• Mom"s diseases. It is believed that cryptorchidism can develop due to the negative impact on the fetus, which occurs if the pregnant woman has rubella, chickenpox, measles, toxoplasmosis. Sometimes diabetes is considered the "culprit" of non-descent of the testicles.
• Hereditary physiological problems. Some anatomical features of the structure of the body can translate from grandfather or dad for the baby. Thus, the shortening of the spermatic cord, the narrow inguinal canal through which the testicle must pass, may well become a mechanical obstacle to the gonad.
• Medicines. It has been scientifically proven that if the mother took during pregnancy at the same time "Ibuprofen" with "Aspirin" or "Paracetamol", then the risk of developing cryptorchidism is 16 times higher than in the fetus of a woman who has not taken such drugs.

Another theory has been put forth by contemporary scientists to explain the phenomenon of cryptorchidism. They attempted to explain the absence of testosterone and insensitivity to it by blaming the male fetus’s germ cells for an immune system attack from the mother. This version states that the protective cells start to perceive the male sex glands as an alien microbe and attempt to block their vital activity in every manner. Nevertheless, there is currently no solid scientific evidence to support this version.

One or both testicles may fail to descend into the scrotum prior to birth, a condition known as undescended testicles that is common in young boys. During the first few months of life, this problem usually goes away on its own, but in certain situations, medical attention may be required to avoid further complications. Parents should keep an eye on their child’s development and seek medical attention if the issue doesn’t go away because early intervention can lower the risk of issues like testicular cancer or infertility in the future.

Types of pathology

True and false cryptorchidism are the two varieties. In the first instance, the testicle is either dislocated close to the inguinal ring or stays in the abdominal cavity or inguinal canal. This is a very prevalent form of the disease; in theory, the sex gland can be manually lowered into the scrotum, but in reality, this is not always possible.

Another prevalent issue is false cryptorchidism. However, the sex gland can be manually moved back to its correct location in cases like this. Increased tone in the muscle responsible for raising the testicles is linked to the condition. This condition is also known by doctors as "migrating cryptorchidism."

The testicles can frequently emerge from the scrotum and reappear in children for up to eight years. This typically occurs when the baby’s muscle tone rises, as in the case of extreme fear or cold.

Another type of cryptorchidism is ectopia, in which the sexual iron is situated anywhere in the inguinal zone, at the base of the penis, or beneath the skin of the thigh. It is impossible to manually return the testicle to the scrotum, despite the fact that it can be felt. This type of pathology is regarded as the most severe and is undoubtedly one of the most important factors contributing to male infertility.

Both unilateral and bilateral cryptorchidism are possible. Additionally, the undescended side is complete, left-sided, and right-sided.

Signs

A child who has cryptorchidism is painless and uncomfortable. Until the boy reaches adolescence, anyway.

The gonad receives more blood during puberty, which compresses the testicle and produces uncomfortable pulling sensations when the peritoneum is tensed.

These sensations typically manifest during defecation, coughing, physical exertion, particularly if the abdominal area is actively involved, and sexual arousal.

From birth, changes are evident in the scrotum. The scrotal sac’s visual changes become more noticeable as the child gets older. The scrotum appears underdeveloped and asymmetrical.

Diagnostics

The existence of an undescended testicle can be confirmed by a pediatric surgeon. After learning about the entire family history, he will make a determination regarding the kind and nature of the undescended testicle and, in turn, the potential for recovery. Manual examination of the groin canal and scrotal sac is not dependable or informative enough. A baby’s testicles are tiny, easy to miss in the inguinal canal, and theoretically impossible to feel in the abdominal cavity.

Therefore, an ultrasound examination is thought to be the most accurate and informative diagnostic technique.

The diagnostician locates the testicle, measures it, assesses its condition (atrophied or alive), looks for pathological changes, and determines whether the sex gland can be lowered into the scrotum. To find out the amount of testosterone in your blood and whether your testicles are working, you will need to donate blood to hormones in addition to passing standard blood and urine tests.

Treatment

Special care is not needed for false cryptorchidism, in which the sex gland "walks" from the scrotum to the scrotum. After seven to eight years, when the inguinal ring contracts, it usually disappears. However, a surgeon must constantly monitor this type of pathology. You’ll need to see this expert more frequently.

There are two methods of treating true cryptorchidism: medication and surgery. When the testicle is close to the scrotum and has only marginally failed to reach its destination, medication treatment makes sense. Only 30–50% of the sex gland’s movement toward the scrotum is aided by conservative therapy. Consequently, physicians can only ensure a 60–90% chance of treatment success when the testicle still has a short way to go.

Surgery is required if the sex gland in the abdominal cavity has stopped functioning, and waiting to treat the condition with medicine is not advised.

Therapy starting between the ages of six months and one year yields the best results. But if the child has already entered adolescence, when testosterone levels naturally rise, it makes no sense.

They use "Choriognin" or "Pregnyl" (hCG drugs) as a form of treatment; injections are administered in courses according to the doctor’s recommended age-appropriate dosage. According to statistics, after being cured of cryptorchidism with medication, the condition recurs in about one in five children. Reviews from parents who chose to treat their child with drugs suggest that these figures are higher and that the illness recurs far more frequently than reported by official sources.

Surgery is thought to be a more dependable form of care. Children as young as 9 or 10 months old can have it done, but surgeons usually take their time and wait until the child is 2 years old. Surgery becomes unnecessary after 7-8 years because at that point the body starts to go through puberty. The likelihood that the testicle that is returned to the site will develop sperm of appropriate quality, function normally, and supply the boy’s body with male sex hormones increases with the age of the child at the time of the procedure.

The "lost" testicle may be removed if the illness was discovered after the child turned 8 or 10 years old. It will not function even if it has not atrophied, and the likelihood of it developing malignant tumors rises significantly. Laparoscopy is used to perform the procedure, which greatly speeds up and simplifies the recuperation process. Unfortunately, only a few types of true cryptorchidism have a chance to preserve and enhance the function of the sex gland. The testicle is immediately removed in cases of ectopia.

The sex gland actually suffers and changes more the longer it is located in the abdominal cavity or beneath the skin (as in the case of ectopia).

During the intrauterine development stage, the initial alterations take place. Because the temperature in the scrotum is lower than in the abdominal or subcutaneous region, the seminal function is disrupted and the composition of the tissues changes.

The child is prescribed antibiotics, dressings, and, following the removal of the stitches, a special massage during the rehabilitation period.

Parents should be aware of cryptorchidism because it can prevent problems later in life if it is detected early. Having your child examined by a pediatrician on a regular basis can help you track their development and identify any problems early.

Within the first few months, cryptorchidism usually goes away on its own. If it doesn’t, though, surgery or medical intervention might be required to guarantee normal development and growth.

Parents can ensure a bright and healthy future for their child by making the best decisions for their well-being by being informed and understanding the condition.

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