Undescended testes is a congenital disorder in which one or both testes fail to descend into the scrotum, remaining in the abdomen or inguinal canal or at the external ring. Although this condition, also known as cryptorchidism, may be bilateral, it more commonly affects the right testis. True undescended testes remain along the path of normal descent, whereas ectopic testes deviate from that path. If bilateral cryptorchidism persists untreated into adolescence, it may result in sterility, make the testes more vulnerable to trauma, and significantly increase the risk of testicular cancer, presumably due to the higher temperature of the abdominal cavity.
The mechanism whereby the testes descend into the scrotum is still unexplained. Some evidence is available to implicate hormonal factors — most likely androgenic hormones from the placenta, maternal or fetal adrenals, or the immature fetal testis and, possibly, maternal progesterone or gonadotropic hormones from the maternal pituitary.
Researchers have linked undescended testes to the development of the gubernaculum, a fibromuscular band that connects the testes to the scrotal floor. In the normal male fetus, testosterone stimulates the formation of the gubernaculum. This band probably helps pull the testes into the scrotum by shortening as the fetus grows. Thus, cryptorchidism may result from inadequate testosterone levels or a defect in the testes or the gubernaculum.
Because the testes normally descend into the scrotum during the eighth month of gestation, cryptorchidism most commonly affects premature neonates. (It occurs in 30% of premature male neonates but in only 3% to 4% of those born at term.) In about 80% of affected infants, the testes descend spontaneously during the first year; in the rest, the testes may descend later.
In the young boy with unilateral cryptorchidism, the testis on the affected side isn’t palpable in the scrotum, and the scrotum may appear underdeveloped. On the unaffected side, the scrotum occasionally appears enlarged as a result of compensatory hypertrophy. After puberty, uncorrected bilateral cryptorchidism prevents spermatogenesis and results in infertility, although testosterone levels remain normal.
❑ Buccal smear determines genetic sex by showing a male sex chromatin pattern.
❑ Serum gonadotropin confirms the presence of testes by assessing the level of circulating hormone.
If the testes don’t descend spontaneously by age 1 year, surgical correction may be indicated. Orchiopexy secures the testes in the scrotum and is commonly performed before the boy reaches age 4 (optimum age is 1 to 2). Orchiopexy prevents sterility and excessive trauma from abnormal positioning. It also prevents harmful psychological effects. Human chorionic gonadotropin (hCG) or testosterone may be given to stimulate descent. However, hormonal therapy with hCG is ineffective if the testes are located in the abdomen.
❑ Encourage parents of the child with undescended testes to express their concern about his condition. Provide information about causes, available treatments, and the ultimate effect on reproduction. Emphasize that, especially in premature neonates, the testes may descend spontaneously.
❑ If orchiopexy is necessary, explain the surgery to the child, using terms he understands. Tell him that a rubber band may be taped to his thigh for about 1 week after surgery to keep the testis in place. Explain that his scrotum may swell but shouldn’t be painful.
After orchiopexy:
❑ Monitor vital signs and intake and output. Check dressings. Encourage coughing and deep breathing. Watch for urine retention.
❑ Keep the operative site clean. Tell the child to wipe from front to back after defecating. If a rubber band has been applied to keep the testis in place, maintain tension, but make sure it isn’t too tight.
❑ Encourage parents to participate in postoperative care, such as bathing or feeding the child. Also urge the child to do as much for himself as possible.
Review other book chapters online related to Cryptorchidism:
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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Title: Professional Guide to Diseases (Eighth Edition)
Authors: Springhouse
Publisher: Lippincott Williams & Wilkins
Copyright: 2005
ISBN: 1-58255-370-X
» Next page: Cryptorchidism (The 5-Minute Pediatric Consult)
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