Niezstąpione jądra
Objawy
Kryptorchizm, definiowany jako brak zstąpienia jednego lub obu jąder do moszny przed lub w pierwszych miesiącach życia, jest diagnozowany na podstawie braku wyczuwalności jądra w mosznie podczas badania palpacyjnego. Około 80% jąder niezstąpionych jest wyczuwalnych w pachwinie (jądra badalne), natomiast 20% pozostaje niebadalnych, co wymaga dalszej diagnostyki. Kryptorchizm występuje u 3% donoszonych noworodków i 30% wcześniaków, z samoistnym zstąpieniem jąder w 80% przypadków w ciągu pierwszego roku życia, głównie w pierwszych trzech miesiącach. Niezstąpienie jądra po 6 miesiącu życia wskazuje na konieczność interwencji chirurgicznej, gdyż opóźnienie leczenia zwiększa ryzyko powikłań, takich jak niepłodność (10-30% przy jednostronnym, >90% przy obustronnym kryptorchizmie) oraz rozwój raka jądra, którego ryzyko jest 5-10-krotnie wyższe niż w populacji ogólnej. Wczesna orchidopeksja, zalecana między 6 a 12 miesiącem życia, zmniejsza ryzyko niepłodności i nowotworu, choć nie eliminuje go całkowicie.
Symptomy niezstąpionych jąder
Niezstąpione jądra (kryptorchizm) to stan, w którym jedno lub oba jądra nie przemieściły się do moszny przed urodzeniem lub w pierwszych miesiącach życia dziecka. Głównym objawem niezstąpionego jądra jest nieobecność jądra w mosznie, co można zauważyć podczas badania fizykalnego noworodka lub niemowlęcia.12 Stan ten jest bezbolesny i nie wpływa na oddawanie moczu.34
Fizycznie niezstąpione jądro objawia się pustą, mniejszą lub niedorozwiniętą moszną po stronie, gdzie jądro nie zstąpiło. W przypadku gdy niezstąpione są oba jądra, moszna wygląda na nienaturalnie małą i płaską.56 Jeśli tylko jedno jądro jest niezstąpione, moszna może wyglądać asymetrycznie – pełna z jednej strony, a pusta z drugiej strony.7
Istotną kwestią jest fakt, że niezstąpione jądra same w sobie nie powodują bólu ani dyskomfortu. Chłopcy z niezstąpionymi jądrami zwykle nie odczuwają żadnych dolegliwości.89 Ból może pojawić się jedynie w przypadku powikłań, takich jak skręt powrózka nasiennego (torsio testis), który jest stanem nagłym wymagającym natychmiastowej interwencji medycznej.10
Diagnoza i rozpoznanie
Niezstąpione jądra są zazwyczaj wykrywane podczas badania fizykalnego noworodka krótko po urodzeniu lub podczas rutynowych badań kontrolnych w pierwszych tygodniach życia.11 Diagnozę stawia się, gdy lekarz nie może wyczuć jądra w mosznie podczas badania palpacyjnego.12
U około 80% chłopców z niezstąpionymi jądrami jądro można wyczuć w pachwinach – są to tzw. jądra badalne (palpable). Pozostałe 20% to jądra niebadalne (nonpalpable), których nie można zlokalizować podczas badania fizykalnego – mogą one znajdować się w jamie brzusznej lub być całkowicie nieobecne.1314
Należy odróżnić niezstąpione jądra od jąder wędrujących (retractile testes), które mogą samoistnie poruszać się między moszną a pachwiną w wyniku odruchu mięśniowego moszny. Jądro wędrujące można łatwo sprowadzić z powrotem do moszny podczas badania lekarskiego.115 Z kolei jądro wstępujące (ascending testis) to jądro, które pierwotnie znajdowało się w mosznie, ale później powróciło do pachwiny i nie daje się łatwo sprowadzić ręcznie do moszny.1
Naturalny przebieg schorzenia
Kryptorchizm występuje u około 3% donoszonych noworodków płci męskiej oraz u około 30% wcześniaków.1617 W większości przypadków (około 80%) jądra zstępują samoistnie w ciągu pierwszego roku życia, najczęściej w pierwszych trzech miesiącach.16
Jeśli jądro nie zstąpiło do moszny do 3-4 miesiąca życia, prawdopodobieństwo samoistnego zstąpienia maleje.1 W przypadku gdy jądro pozostaje niezstąpione po ukończeniu przez dziecko 6 miesięcy, jest bardzo mało prawdopodobne, aby zstąpiło samoistnie, a stan taki wymaga interwencji medycznej.1819
Konsekwencje nieleczonego kryptorchizmu
Nieleczone niezstąpione jądra mogą prowadzić do szeregu poważnych konsekwencji zdrowotnych, które mogą wpływać na jakość życia pacjenta w przyszłości.14 Główne powikłania to:
Zagrożenie płodności
Niezstąpione jądra zwiększają ryzyko problemów z płodnością w życiu dorosłym.3 Dzieje się tak dlatego, że jądra powinny znajdować się w mosznie, gdzie temperatura jest o 3-5 stopni niższa niż wewnątrz ciała. Wyższa temperatura w jamie brzusznej lub pachwinie może upośledzać rozwój jąder i produkcję zdrowych plemników.57
Badania wskazują, że zmiany związane z płodnością mogą pojawiać się w niezstąpionym jądrze już u dzieci w wieku jednego roku.20 U mężczyzn z jednostronnym niezstąpionym jądrem ryzyko niepłodności wynosi około 10-30%.14 Natomiast w przypadku obustronnego kryptorchizmu, ryzyko niepłodności jest znacznie wyższe:
- U osób z nieleczonym obustronnym kryptorchizmem wskaźnik niepłodności może przekraczać 90%14
- Nawet po przeprowadzeniu orchidopeksji (zabiegu sprowadzenia jądra do moszny) w przypadku obustronnego kryptorchizmu płodność pozostaje znacznie obniżona – szacuje się, że o co najmniej 38%1416
Zwiększone ryzyko raka jądra
Mężczyźni urodzeni z niezstąpionymi jądrami mają wyższe ryzyko rozwoju nowotworu jądra niż populacja ogólna.5 Ryzyko to jest 5-10 razy wyższe w porównaniu do mężczyzn, których jądra zstąpiły prawidłowo.321
Istotne jest to, że ryzyko raka jądra może pozostać podwyższone nawet po przeprowadzeniu korekcyjnego zabiegu chirurgicznego, szczególnie jeśli zabieg został opóźniony i przeprowadzony w późniejszym dzieciństwie.3 Badania pokazują, że:
- Ryzyko raka jądra jest około 3 razy wyższe, gdy orchidopeksja zostanie przeprowadzona przed okresem dojrzewania14
- Ryzyko to wzrasta do 5-6 razy, gdy zabieg wykonano po okresie dojrzewania14
- Rak jądra występuje najczęściej między 25 a 40 rokiem życia3
Inne powikłania
Poza problemami z płodnością i zwiększonym ryzykiem raka jądra, niezstąpione jądra mogą prowadzić do innych komplikacji zdrowotnych:722
- Skręt jądra (torsio testis) – występuje, gdy powrózek nasienny ulega skręceniu, co prowadzi do odcięcia dopływu krwi do jądra. Jest to stan nagły wymagający natychmiastowej interwencji medycznej, aby zapobiec trwałemu uszkodzeniu jądra723
- Przepuklina pachwinowa – gdy fragment jelita przedostaje się do moszny. Większość prawdziwych przypadków niezstąpionych jąder jest związana z drożnym wyrostkiem pochwowym20
- Problemy psychologiczne – związane z nietypowym wyglądem narządów płciowych, mogące wpływać na samoocenę chłopca w miarę dorastania724
Znaczenie wczesnej interwencji
Wczesne rozpoznanie i leczenie niezstąpionych jąder ma kluczowe znaczenie dla zminimalizowania ryzyka długoterminowych powikłań zdrowotnych.20 Badania wykazały, że uszkodzenie zdolności jądra do produkcji plemników może rozpocząć się już w 12 miesiącu życia.25
Obecnie zaleca się, aby leczenie niezstąpionego jądra rozpoczynać między 6 a 12 miesiącem życia, a najpóźniej przed ukończeniem 2 lat.2020 Wczesna interwencja ma na celu:
- Zmniejszenie ryzyka niepłodności18
- Obniżenie ryzyka rozwoju raka jądra19
- Ułatwienie wczesnego wykrycia ewentualnych zmian nowotworowych5
- Zapobieganie problemom psychologicznym związanym z wyglądem narządów płciowych7
Obserwacja rozwoju stanu
W przypadku wykrycia niezstąpionego jądra u noworodka, lekarze zwykle zalecają obserwację przez pierwsze 3-6 miesięcy życia, ponieważ w tym okresie jądro może zstąpić samoistnie.7 Jednak obserwacja bez interwencji nie jest zalecana po ukończeniu przez dziecko 1 roku życia, ponieważ opóźnia leczenie, obniża wskaźnik powodzenia zabiegu i prawdopodobnie upośledza spermatogenezę.20
Jeśli jądro nie zstąpiło do moszny do 6 miesiąca życia, dziecko powinno zostać skierowane do urologa dziecięcego lub innego odpowiedniego specjalisty, który pomoże w diagnozie i leczeniu.20 W tym wieku szansa na samoistne zstąpienie jądra jest już bardzo mała.26
Warto dodać, że u dzieci urodzonych przedwcześnie czas obserwacji może być nieco dłuższy – do około 1 roku życia (skorygowanego względem wieku ciążowego).13
Rokownie i efekty leczenia
Rokowanie w przypadku niezstąpionych jąder jest zwykle dobre, szczególnie gdy leczenie zostanie przeprowadzone we wczesnym okresie życia. Zabieg orchidopeksji ma wysoki wskaźnik powodzenia – około 90-98% w przypadku jąder badalnych (palpable) zlokalizowanych blisko moszny.219
Efekty leczenia w kontekście przyszłej płodności są zróżnicowane i zależą od kilku czynników:
- W przypadku jednostronnego niezstąpienia jądra wskaźnik płodności po zabiegu wynosi około 90%, co jest bliskie poziomowi populacji ogólnej2116
- U pacjentów z obustronnym niezstąpieniem jąder wskaźnik płodności jest niższy i wynosi około 80%21
- Wiek, w którym przeprowadzono zabieg, ma istotny wpływ na przyszłą płodność – im wcześniej, tym lepsze wyniki20
W kontekście ryzyka raka jądra, wczesna orchidopeksja może zmniejszyć to ryzyko, ale nie eliminuje go całkowicie:27
- Mężczyźni z historią niezstąpionych jąder, nawet po udanym leczeniu, powinni regularnie przeprowadzać samobadanie jąder17
- Wczesne przeprowadzenie zabiegu (przed okresem dojrzewania) zmniejsza ryzyko rozwoju nowotworu9
- Ryzyko raka jądra u pacjentów z niezstąpionym jądrem zależy również od położenia jądra – im wyżej położone jądro, tym wyższe ryzyko rozwoju nowotworu27
Potencjalne komplikacje pozabiegowe
Choć orchidopeksja jest bezpiecznym zabiegiem z wysokim wskaźnikiem powodzenia, mogą wystąpić pewne komplikacje:1019
- Głównym ryzykiem jest utrata (zanik) jądra19
- Ryzyko to wzrasta, im dalej jądro musi zostać przemieszczone, aby dotrzeć do moszny19
- Najpoważniejszym powikłaniem wszystkich rodzajów orchidopeksji jest utrata dopływu krwi do jądra, prowadząca do utraty jądra z powodu niedokrwiennego zaniku lub zwłóknienia16
- Po zabiegu dziecko może odczuwać nudności przez pierwsze 24 godziny, a okolica pachwiny będzie prawdopodobnie bolesna i pojawi się siniak oraz obrzęk10
Warto podkreślić, że powikłania po zabiegu są stosunkowo rzadkie (około 1%), a wskaźnik powodzenia orchidopeksji jest wysoki (około 95%).27
Dalsze postępowanie i monitorowanie
Po przeprowadzeniu zabiegu orchidopeksji bardzo ważne jest długoterminowe monitorowanie pacjenta ze względu na utrzymujące się ryzyko rozwoju raka jądra oraz możliwe problemy z płodnością.17
Rekomendowane postępowanie obejmuje:
- Regularne badania kontrolne u urologa lub lekarza pediatry27
- Po osiągnięciu dojrzałości płciowej, samobadanie jąder raz w miesiącu w celu wczesnego wykrycia ewentualnych guzów1714
- Informowanie pacjenta o jego historii medycznej, gdy dorośnie, aby był świadomy zwiększonego ryzyka raka jądra28
- W przypadku mężczyzn planujących potomstwo, możliwe jest przeprowadzenie badań płodności, takich jak analiza nasienia14
Kluczowe jest, aby młodzi mężczyźni z historią niezstąpionych jąder byli świadomi zwiększonego ryzyka raka jądra i znali technikę samobadania, co znacznie zwiększa szanse na wczesne wykrycie potencjalnego nowotworu.1425
Edukacja pacjenta i rodziny
Ważnym aspektem opieki nad pacjentem z niezstąpionym jądrem jest edukacja dziecka (kiedy dorośnie) oraz jego rodziny. Rodzice powinni być poinformowani o:28
- Potrzebie wczesnego leczenia i jego znaczeniu dla przyszłego zdrowia dziecka29
- Możliwych długoterminowych konsekwencjach zdrowotnych, takich jak problemy z płodnością i zwiększone ryzyko raka jądra25
- Znaczeniu regularnych badań kontrolnych po zabiegu27
- Technice samobadania jąder, którą chłopiec powinien stosować po osiągnięciu dojrzałości płciowej24
Dzięki wczesnemu wykryciu i odpowiedniemu leczeniu niezstąpionych jąder, a także właściwej edukacji i długoterminowemu monitorowaniu, można znacznie zmniejszyć ryzyko poważnych powikłań zdrowotnych i zapewnić dziecku najlepsze możliwe rokowanie na przyszłość.10
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Materiały źródłowe
- #1 Undescended testicle – Symptoms and causes – Mayo Clinichttps://www.mayoclinic.org/diseases-conditions/undescended-testicle/symptoms-causes/syc-20351995
Not seeing or feeling a testicle in the scrotum is the main symptom of an undescended testicle. […] An undescended testicle often is found during an exam done shortly after birth. If the testicle hasn’t moved into the scrotum by 3 to 4 months of age, the condition likely won’t correct itself. […] Treating an undescended testicle when your child is still a baby might lower the risk of health problems later in life. These include cancer of the testicles and not being able to get a partner pregnant, also called infertility. […] Older boys from infants to preteens who have descended testicles at birth might appear to be missing a testicle later. This might be a symptom of a retractile testicle, which moves back and forth between the scrotum and the groin. The testicle might be easily guided by hand into the scrotum during a physical exam. A retractile testicle is due to a muscle reflex in the scrotum. […] An ascending testicle, which has returned to the groin. The testicle can’t be easily guided by hand into the scrotum. Another name for this is an acquired undescended testicle.
- #2 Undescended Testicles (Cryptorchidism): Causes & Treatmenthttps://my.clevelandclinic.org/health/diseases/17594-undescended-testicles
During pregnancy, testicles develop in the abdominal cavity. In most cases, they drop into the scrotum before birth. Undescended testicles dont drop before birth. If the testicles dont descend after six months, your child may need surgery or hormone therapy. […] Undescended testicles are when the testicles fail to drop into the scrotum before birth or in the first few months of life. […] The main symptom of undescended testicles is the absence of a testicle in one or both sides of the scrotum. There are usually no other symptoms. Undescended testicles dont cause pain or affect your babys ability to urinate (pee). […] If testicles dont drop into the scrotum, they may not function properly or produce healthy sperm. They can cause infertility later in life. […] Surgery to fix undescended testicles has a high success rate about 98% effective. In most cases, the testicles develop normally in the scrotum and produce healthy sperm later in life. […] Talk to your childs healthcare provider if your childs testicles havent descended after six months.
- #3 Undescended testicles | Better Health Channelhttps://www.betterhealth.vic.gov.au/health/conditionsandtreatments/undescended-testicles
A boy with undescended testicles will have an empty scrotum on one or both sides. The condition is painless, and urination is not affected. […] Undescended testicles are linked to a range of health problems and conditions, including hernia, testicular cancer and infertility. […] In about half the babies with undescended testicles at birth, the testicle will reach the scrotum in the first three months of life. If the testicle is still undescended at three months of age the baby needs to see a paediatric surgeon. […] Undescended testicles are diagnosed at three months of age if the testicle has failed to descend into the scrotum by that time. […] Surgery is the best treatment for undescended testicles. Ideally, the child should be aged between six months and one year at the time of surgery.
- #3 Undescended testicles | Better Health Channelhttps://www.betterhealth.vic.gov.au/health/conditionsandtreatments/undescended-testicles
About 10 per cent of males who undergo surgical correction experience reduced fertility later in life. […] The risk of testicular cancer is five to 10 times higher for males with undescended testicles than for the general male population. This risk may remain even after corrective surgery, particularly if surgery is delayed to later in childhood. Testicular cancer usually occurs between the ages of 25 and 40 years.
- #4 Undescended Testes in Children | Cedars-Sinaihttps://www.cedars-sinai.org/health-library/diseases-and-conditions—pediatrics/u/undescended-testes-in-children.html
Undescended testes means that 1 or both of the male testes have not passed down (descended) into the scrotal sac. This is a condition seen in some newborn baby boys. Most children don’t have symptoms when they have an undescended testicle. […] Symptoms can be a bit different in each child. The most common sign is when a healthcare provider cant feel the testes during an exam. […] In many cases, the testes descend on their own into the scrotum by age 3 months. In most cases, the testes pass down by age 6 months without any treatment. […] If testes dont descend, this can cause problems, such as: Infertility. This is most common when both testes dont descend. Risk for testicular cancer. This risk increases greatly by age 30 or 40.
- #5 Undescended Testicles (Cryptorchidism) | Boston Children’s Hospitalhttps://www.childrenshospital.org/conditions/undescended-testes-cryptorchidism
In a baby affected by undescended testicles, one or both of his testicles either appear to be missing or cannot be felt in the scrotum. If both testicles are undescended, the scrotum will look unusually small and flat. If only one testicle is affected, the scrotum may look lopsided. […] Undescended testicles can increase the risk of infertility. Normally, when the testicles are in the scrotum, theyâre about three to five degrees cooler than they would be if they remained inside the body’s abdominal cavity. The warmer temperatures inside the body may impair the development of the testicles and may affect the production of healthy sperm when the boy is older. […] Undescended testicles may increase the risk of infertility, especially if both testicles are affected. However, boys who have one undescended testicle tend to father children at the same rate as those who are not affected by the condition at all.
- #5 Undescended Testicles (Cryptorchidism) | Boston Children’s Hospitalhttps://www.childrenshospital.org/conditions/undescended-testes-cryptorchidism
Boys who have two undescended testicles a much lower percentage of patients do have a significantly lower fertility rate. A child with undescended testicles is slightly more prone to develop testicular cancer, even after corrective surgery. However, surgery performed before puberty may reduce the risk of developing cancer. […] Boys born with undescended testicles are slightly more prone to testicular cancer, even after corrective surgery, and at a rate of less than 1 percent. However, recent studies suggest that surgical repositioning may help in early detection of a testicular mass prior to the spread of disease, which may reduce the rate of malignancies.
- #6https://www.healthychildren.org/English/health-issues/conditions/genitourinary-tract/Pages/Undescended-Testicles.aspx
In some boys, especially those who are born premature, one or both testicles do not make it down to the scrotum before birth. This is known as cryptorchidism, more commonly called undescended testicles. […] Typically, boys with undescended testicles have no symptoms of pain or discomfort. The scrotum may appear small and underdeveloped. If only one testicle is undescended, the scrotum may look asymmetrical (full on one side, empty on the other). […] If your child’s testicle has not come down into the scrotum on its own by 6 months of age, they will likely need treatment. It is relatively rare for undescended testicles to fall into proper position after 6 months of age. […] In some cases, the undescended testicle may be twisted, in a condition called testicular torsion. As a result, its blood supply may be stopped, causing pain in the inguinal (groin) or scrotal area. If this situation is not corrected promptly, the testicle can be damaged severely and permanently.
- #7 Undescended testeshttps://www.rch.org.au/kidsinfo/fact_sheets/undescended_testes/
The main sign of undescended testes is one testis (a single testicle) or both testes missing from the scrotum. Undescended testes will not cause your child any problems with urination, and will not cause any pain, unless the cord attached to the testis (spermatic cord) becomes twisted. […] If your baby is born with undescended testes, this will be picked up by your Maternal and Child Health Nurse or your doctor shortly after birth. Your baby’s condition will be monitored. […] If your baby’s testes were in the scrotum at birth, and one or both of them disappears from the scrotum, see your GP. You will be referred to a paediatrician or paediatric surgeon. It is very important that the testes be brought down to the scrotum. […] If the testes do not come down, there is a risk of ongoing health issues such as: Torsion the spermatic cord can become twisted and this can cut off the blood supply to the testes. Hernia when a loop of bowel comes into the scrotum. Reduced fertility the body temperature in the abdomen is higher than in the scrotum, and this can affect sperm production in the testes. Risk of testicular cancer this happens in a relatively low number of boys. The risk is usually less than 1 in 100. Poor self-esteem due to having abnormal looking genitals.
- #7 Undescended testeshttps://www.rch.org.au/kidsinfo/fact_sheets/undescended_testes/
For babies born with undescended testes, the testes may come down by themselves in the first three months after birth, and no treatment is needed. […] If the testes do not come down by themselves, your child will be monitored, and if they are not down after six months, an operation called an orchidopexy is needed. An orchidopexy brings the testis down into its normal location in the scrotum. […] An operation is needed if the testes do not move down by themselves by six months of age. This is done to reduce ongoing health issues.
- #8 Undescended Testis | Symptoms, Diagnosis & Treatmenthttps://www.cincinnatichildrens.org/health/u/undescended-testis
Undescended testicles (cryptorchidism) refer to a condition in which the testicle does not drop and cannot be brought into the scrotum with external manipulation. This occurs in 3 percent of newborn males and up to 21 percent in premature male newborns. Most testes drop by 3-4 months of age. […] The testicle that has not dropped does not cause pain. The scrotal sac may look smoother, smaller or more flat than normal.
- #9 Undescended testicle // Middlesex Healthhttps://middlesexhealth.org/learning-center/diseases-and-conditions/undescended-testicle
Not seeing or feeling a testicle in the scrotum is the main symptom of an undescended testicle. […] An undescended testicle often is found during an exam done shortly after birth. If the testicle hasn’t moved into the scrotum by 3 to 4 months of age, the condition likely won’t correct itself. […] Treating an undescended testicle when your child is still a baby might lower the risk of health problems later in life. These include cancer of the testicles and not being able to get a partner pregnant, also called infertility. […] Older boys from infants to preteens who have descended testicles at birth might appear to be missing a testicle later. This might be a symptom of a retractile testicle, which moves back and forth between the scrotum and the groin. […] The testicles need to be slightly cooler than regular body temperature to develop and work well. The scrotum provides this cooler place. Complications of a testicle not being located where it’s supposed to be include testicular cancer.
- #9 Undescended testicle // Middlesex Healthhttps://middlesexhealth.org/learning-center/diseases-and-conditions/undescended-testicle
Men who’ve had an undescended testicle have a higher risk of testicular cancer. […] Fertility problems make it harder to get a partner pregnant. They’re more likely to happen in men who’ve had an undescended testicle. […] Surgery to correct an undescended testicle might lower the risk of testicular cancer. But the cancer risk doesn’t go away completely. […] Orchiopexy is the most common surgery to fix a single undescended testicle. It has a success rate of nearly 100%. Most of the time, the risk of fertility problems goes away after surgery for a single undescended testicle. Surgery with two undescended testicles brings less of an improvement. Surgery also might lower the risk of testicular cancer, but it doesn’t get rid of the risk.
- #10 Undescended testicles | Great Ormond Street Hospitalhttps://www.gosh.nhs.uk/conditions-and-treatments/conditions-we-treat/undescended-testicles/
This is when the childs testicles are not in their usual place in the scrotum. Generally, only one of the testicles is affected, but on rare occasions, both testicles fail to travel to the scrotum. Both testicles should be in the scrotum by the time the child is one year old. […] Usually, there will not be any symptoms at all, other than not being able to feel the testicles in the scrotum. The child will not be in pain, and the undescended testicles will not interfere with any bodily function. […] However, if one of the testicles becomes twisted (testicular torsion), this will be painful, either in the groin area or the abdomen, depending on the location of the testicle at the time. […] The amount of sperm and fertility levels seem lower in men who have had undescended testicles, and even lower if they were not treated early in childhood.
- #10 Undescended testicles | Great Ormond Street Hospitalhttps://www.gosh.nhs.uk/conditions-and-treatments/conditions-we-treat/undescended-testicles/
Children with undescended testicle have a higher risk of testicular cancer in the future. […] The child may feel sick for the first 24 hours. […] The child’s groin will probably feel sore for a while after the operation and will look bruised and swollen. This will improve in the days following the operation. […] When the undescended testicles are treated in early childhood, the outlook is good. The child will have normal fertility levels unless there were problems with the testicles themselves.
- #11 Undescended Testes | Children’s Hospital of Philadelphiahttps://www.chop.edu/conditions-diseases/undescended-testes
As the male fetus grows, the testicles develop near the kidneys. The testicles travel down into the scrotum between 28 and 40 weeks gestation. At birth, 2 to 3 percent of boys will have one testicle that is not in the scrotum. The final descent of the testis may take up to six months after birth, but usually occurs within three months of birth. […] If a testicle has not reached the scrotum by the time the baby is 6 months of age, it is considered an undescended testicle. This can occur to one or both testicles. […] Boys generally do not have symptoms associated with an undescended testicle. It is discovered during a physical exam. On exam, the undescended testicle may be felt anywhere along the path that the testicle takes as it descends.
- #12 Undescended Testes in Children – Stanford Medicine Children’s Healthhttps://www.stanfordchildrens.org/en/topic/default?id=undescended-testes-in-children-90-P03081
Symptoms can be a bit different in each child. The most common sign is when a healthcare provider cant feel the testes during an exam. Most children don’t have symptoms when they have an undescended testicle. […] In many cases, the testes descend on their own into the scrotum by age 3 months. In most cases, the testes pass down by age 6 months without any treatment. […] If testes dont descend, this can cause problems such as infertility, higher risk of testicular cancer, and other problems.
- #13 Cryptorchidism: Practice Essentials, History of the Procedure, Problemhttps://emedicine.medscape.com/article/438378-overview
Approximately 80% of undescended testes are palpable and 20% are nonpalpable. Most intra-abdominal testes are found within a few centimeters of the internal ring. Absent or vanishing testes are thought to be due to an intrauterine or perinatal vascular event, most likely during late gestation since most of these testicular nubbins are found below the internal inguinal ring. […] Impairment of germ cell maturation is a well-recognized consequence of cryptorchidism. Early reposition of the testis into the scrotum has been a mainstay of treatment to reduce the risk of infertility; however, even with successful orchidopexy at age 6-12 months, 20-25% of boys with nonsyndromic cryptorchidism have compromised fertility potential. […] Males with undescended testis are 40 times as likely to develop testicular cancer as males without undescended testis. Ten percent of testicular cancer cases involve patients with undescended testis. […] The location of the undescended testis affects the relative risk of testicular cancer. Up to 50% of malignant testicular tumors associated with cryptorchidism involve intra-abdominal testes.
- #13 Cryptorchidism: Practice Essentials, History of the Procedure, Problemhttps://emedicine.medscape.com/article/438378-overview
Cryptorchidism is the most common genital problem encountered in pediatrics. Cryptorchidism literally means hidden or obscure testis and generally refers to an undescended or maldescended testis. Incidence rates are higher in boys who are born preterm, small for gestational age, or with birth weight under 2500 g. […] Untreated cryptorchidism clearly has deleterious effects on the testis over time. Understanding the abnormalities of morphogenesis and the molecular and hormonal milieu associated with cryptorchidism is critical to contemporary diagnosis and treatment of this extremely common entity. […] An undescended testis may descend spontaneously during the first few months of life but is unlikely to do so after 6 months (corrected for gestational age). Cryptorchidism may also be acquired, with an initially descended testis ascending out of the scrotum.
- #14 Cryptorchidism – StatPearls – NCBI Bookshelfhttps://www.ncbi.nlm.nih.gov/books/NBK470270/
Cryptorchidism, the most prevalent congenital condition involving male genitalia, is characterized by the absence of at least one testicle from the scrotum; this often manifests unilaterally or bilaterally, with a higher frequency of involvement observed in the right testicle. Approximately 3% of full-term and 30% of premature male infants are born with undescended testicles, necessitating a nuanced understanding among healthcare professionals. […] Untreated cryptorchidism can lead to potential long-term complications such as fertility issues, testicular cancer, testicular torsion, inguinal hernias, and psychological impacts. […] If the testis has not descended by 6 months, surgical correction through orchiopexy is recommended to minimize risks and potential complications. […] Approximately 20% to 30% of undescended testes are nonpalpable.
- #14 Cryptorchidism – StatPearls – NCBI Bookshelfhttps://www.ncbi.nlm.nih.gov/books/NBK470270/
Spontaneous descent is unlikely if the testis has not descended by 6 months, and surgical correction should be considered. […] Undescended testes can lead to potential long-term complications, including decreased fertility (particularly true in cases affecting both testicles), an increased risk of testicular germ cell tumors (with an overall risk of less than 1%), testicular torsion, inguinal hernias, and psychological issues if left untreated. […] Approximately 10% to 30% of individuals with unilateral undescended testis may experience infertility, with the risk escalating from 35% to 65% or higher for those with bilateral disease. […] If bilateral cryptorchid testes are left untreated, the infertility rate can exceed 90%. […] Cryptorchidism is associated with male infertility in adulthood, primarily due to poor semen quality, which can be linked to compromised Sertoli cell function and its impact on Leydig cell function.
- #14 Cryptorchidism – StatPearls – NCBI Bookshelfhttps://www.ncbi.nlm.nih.gov/books/NBK470270/
The most apparent sign in a patient with a cryptorchid testis is the absence of a palpable scrotal testicle. […] Several factors contribute to reduced fertility in those with cryptorchidism. One key factor is hyperthermia, which can impair spermatogenesis, as the intrascrotal temperature is several degrees cooler than ectopic positions. […] Men with undescended testes often face reduced fertility, which may persist even following orchidopexy. […] Specifically, approximately 10% to 30% of patients with a unilateral cryptorchid testicle will develop infertility, and azoospermia is found in 13% of individuals with unilateral undescended testicles. […] In contrast, azoospermia rates can increase to around 90% in patients with untreated bilateral cryptorchidism. […] Even after orchiopexy for bilateral cryptorchidism, fertility remains significantly diminished, estimated at least 38%.
- #14 Cryptorchidism – StatPearls – NCBI Bookshelfhttps://www.ncbi.nlm.nih.gov/books/NBK470270/
The risk of testicular cancer is approximately 3 times higher than that of the general population when orchiopexy is performed before puberty. However, this risk increases to 5 to 6 times higher when orchiopexy is conducted after puberty. […] Early detection is crucial for the effective treatment of testicular cancer.
- #15 Retractile testicle – Symptoms and causes – Mayo Clinichttps://www.mayoclinic.org/diseases-conditions/retractile-testicle/symptoms-causes/syc-20377197
Symptoms of a retractile testicle include: […] The testicle may be moved by hand from the groin into the scrotum and won’t immediately retreat to the groin. […] The testicle might spontaneously appear in the scrotum and remain there for a time. […] The testicle might spontaneously disappear again for a time. […] Retractile testicle is different from undescended testicle (cryptorchidism). An undescended testicle is one that never entered the scrotum. […] Retractile testicles are generally not associated with complications, aside from a greater risk of the testicle becoming an ascending testicle.
- #16 Cryptorchidism – Wikipediahttps://en.wikipedia.org/wiki/Cryptorchidism
Cryptorchidism, also known as undescended testis, is the failure of one or both testes to descend into the scrotum. About 3% of full-term and 30% of premature infant boys are born with at least one undescended testis. However, about 80% of cryptorchid testes descend by the first year of life (the majority within three months), making the true incidence of cryptorchidism around 1% overall. Cryptorchidism may develop after infancy, sometimes as late as young adulthood, but that is exceptional. […] Undescended testes are associated with reduced fertility, increased risk of testicular germ-cell tumors, and psychological problems when fully-grown. Undescended testes are also more susceptible to testicular torsion (and subsequent infarction) and inguinal hernias. Without intervention, an undescended testicle will usually descend during the first year of life, but to reduce these risks, undescended testes can be brought into the scrotum in infancy by a surgical procedure called an orchiopexy.
- #16 Cryptorchidism – Wikipediahttps://en.wikipedia.org/wiki/Cryptorchidism
Many men who were born with undescended testes have reduced fertility, even after orchiopexy in infancy. The reduction with unilateral cryptorchidism is subtle, with a reported infertility rate of about 10%, compared with about 6% reported by the same study for the general population of adult men. The fertility reduction after orchiopexy for bilateral cryptorchidism is more marked, about 38%, or six times that of the general population. […] One of the strongest arguments for early orchiopexy is reducing the risk of testicular cancer. About one in 500 men born with one or both testes undescended develops testicular cancer, roughly a four- to 40-fold increased risk. The risk of malignancy in the undescended testis is 4 to 10 ten times higher than that in the general population and is about one in 80 with a unilateral undescended testis and one in 40 to one in 50 for bilateral undescended testes. […] The principal major complication of all types of orchiopexy is a loss of the blood supply to the testis, resulting in loss of the testis due to ischemic atrophy or fibrosis.
- #17 Undescended Testes and Retractile Testes – Children’s Health Issues – Merck Manual Consumer Versionhttps://www.merckmanuals.com/home/children-s-health-issues/birth-defects-of-the-urinary-tract-and-genitals/undescended-testes-and-retractile-testes
About 3 of every 100 boys who are born at full term (9 months) have an undescended testis at birth. However, about 30 of every 100 boys born prematurely have an undescended testis. Boys whose family members had undescended testes also are more likely to have the condition. Usually only one testis fails to descend, but in about 10% both testes are affected. […] Undescended testes rarely cause symptoms. However, undescended testes can impair sperm production later in life and increase the risk of testicular cancer. Undescended testes in the abdomen can become twisted (testicular torsion), causing severe pain. Most newborns who have an undescended testis also have an inguinal hernia. […] If the testis has not descended by about 6 months of age in full-term infants and by 1 year of age in premature infants, surgery is needed. Depending on the location of the testis, it may be brought down into the scrotum via a surgical procedure through an open incision or by laparoscopy (in which doctors look inside the abdominal cavity using an endoscope). If the infant has an inguinal hernia, that is also repaired. […] Because children who have had undescended testes are at an increased risk of developing testicular cancer, after puberty, all males should examine their testes for lumps every month.
- #18https://www.nhs.uk/conditions/undescended-testicles/
Undescended testicles are a common childhood condition where a boy’s testicles are not in their usual place in the scrotum. […] In most cases no treatment is necessary, as the testicles will usually move down into the scrotum naturally during the first 3 to 6 months of life. […] But around 1 in 100 boys has testicles that stay undescended unless treated. […] Undescended testicles aren’t painful and your child isn’t at risk of any immediate health problems, but they should be monitored by a doctor in case treatment is needed later on. […] If the testicles haven’t descended by 6 months, they’re very unlikely to do so and treatment will usually be recommended. […] This is because boys with untreated undescended testicles can have fertility problems (infertility) in later life and an increased risk of developing testicular cancer. […] Surgery is ideally carried out before 12 months of age. If undescended testicles are treated at an early age, the risk of fertility problems and testicular cancer can be reduced.
- #19https://www.nhs.uk/conditions/undescended-testicles/treatment/
Undescended testicles will usually move down into the scrotum naturally by the time your child is 3 to 6 months old. […] If the testicles don’t descend by 6 months, it’s very unlikely they will without treatment. […] This is because waiting longer than this may increase a boy’s risk of developing fertility problems (infertility) or testicular cancer later in life. […] The success rate for treating palpable testicles located near the scrotum is estimated to be higher than 90%. […] The operation is slightly less successful in treating impalpable testicles located in the abdomen. […] The main risk is loss (atrophy) of the testicle. […] The chances of this increase the further the testicle has to be moved to get to the scrotum.
- #20 The Undescended Testicle: Diagnosis and Management | AAFPhttps://www.aafp.org/pubs/afp/issues/2000/1101/p2037.html
Early diagnosis and management of the undescended testicle are needed to preserve fertility and improve early detection of testicular malignancy. […] Observation is not recommended beyond one year of age because it delays treatment, lowers the rate of surgical success and probably impairs spermatogenesis. […] By six months of age, patients with undescended testicles should be evaluated by a pediatric urologist or other qualified subspecialist who can assist with diagnosis and treatment. […] Therapy for an undescended testicle should begin between six months and two years of age and may consist of hormone or surgical treatment. […] The most common problems associated with undescended testicles are testicular neoplasm, subfertility, testicular torsion and inguinal hernia. […] As a group, men who have had an undescended testicle have lower sperm counts, poorer quality sperm and lower fertility rates than men whose testicles descended normally.
- #20 The Undescended Testicle: Diagnosis and Management | AAFPhttps://www.aafp.org/pubs/afp/issues/2000/1101/p2037.html
The likelihood of subfertility increases with bilateral involvement and increasing age at the time of orchiopexy. […] For this reason, treatment of the undescended testicle is recommended as early as six months of age and should be completed before age two. […] Although there is little solid evidence, the incidence of testicular torsion is thought to be higher in undescended testes than in normal scrotal testes. […] Most true cases of undescended testicles are associated with a patent processus vaginalis. […] A man with an untreated, undescended testicle and an occult inguinal hernia may present at any time with symptoms and complications typical of any inguinal hernia. […] Watchful waiting is not an option because true undescended testicles rarely descend spontaneously after three months of age.
- #21 Undescended Testes (Testicles; also Cryptorchidism) | Lurie Children’shttps://www.luriechildrens.org/en/specialties-conditions/undescended-testes-testicles-also-cryptorchidism/
In most cases, the procedure has excellent results. Fertility rate after surgery for a single UDT is around 90%. This rate of successful fertility in lower in children with an UDT on both sides (~80%) The risk of testicular malignancy in patients with a history of UDT is five to 10 times greater than the general population with descended testes. The risk is greater for UDT on both sides and for those with intra-abdominal testes. Correction of the UDT prior to puberty helps to decrease the risk of cancer.
- #22 Undescended Testicle | HealthLink BChttps://www.healthlinkbc.ca/healthwise/undescended-testicle
Most of the time, the testicle descends (drops) on its own by the time the baby is 3 months old. If your baby’s testicle hasn’t dropped by the time he is 6 months of age, your doctor may suggest treatment. […] An undescended testicle doesn’t cause pain or other symptoms. The scrotum may look a little smoother or less developed on one side, or the side without a testicle may look smaller and flatter. You can’t feel the testicle in the scrotum on the side where it hasn’t descended. […] Treatment is important because having an undescended testicle increases the risk of: […] Infertility. Damage to a testicle’s sperm-making ability can begin as early as 12 months of age. That’s why many doctors advise treating an undescended testicle by the time a baby is 1 year old and no later than age 2. Treatment helps lower the chance of infertility. […] Cancer of the testicles. Men who were born with undescended testicles have a higher rate of testicular cancer than other men. But this cancer is rare. It can be cured if found early. If you are a young man who was born with an undescended testicle, talk with your doctor about what you should do.
- #23 Signs of cryptorchidism/undescended testicles | Adahttps://ada.com/conditions/cryptorchidism/
Orchidopexies should be performed as early as possible to maximize fertility potential in later life and keep the risk of testicular cancer to a minimum. […] If left uncorrected, cryptorchidism can lead to a higher risk of testicular cancer and can affect fertility. […] Men with a history of cryptorchidism may have lower sperm counts, sperm of poorer quality and lower fertility than men with normally-descended testes. […] Testicular torsion can occur at any age and is about ten times more common among males with cryptorchidism than it is among those with normally-descended testes.
- #24 Undescended Testes in Childrenhttps://phoenixchildrens.staywellsolutionsonline.com/Library/PreventionGuidelines/90,P03081
Undescended testes means that 1 or both of the male testes have not passed down (descended) into the scrotal sac. This is a condition seen in some newborn baby boys. Most children don’t have symptoms when they have an undescended testicle. Symptoms can be a bit different in each child. The most common sign is when a healthcare provider cant feel the testes during an exam. […] In many cases, the testes descend on their own into the scrotum by age 3 months. In most cases, the testes pass down by age 6 months without any treatment. […] If testes dont descend, this can cause problems, such as: Infertility. This is most common when both testes dont descend. Risk for testicular cancer. This risk increases greatly by age 30 or 40. Men with undescended tests will need to do monthly testicular self-exams.
- #25 Undescended Testicle | Kaiser Permanentehttps://healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.undescended-testicle.rt1112
Most of the time, the testicle descends (drops) on its own by the time the baby is 3 months old. If your baby’s testicle hasn’t dropped by the time he is 6 months of age, your doctor may suggest treatment. […] An undescended testicle doesn’t cause pain or other symptoms. The scrotum may look a little smoother or less developed on one side, or the side without a testicle may look smaller and flatter. You can’t feel the testicle in the scrotum on the side where it hasn’t descended. […] Treatment is important because having an undescended testicle increases the risk of: Infertility. Damage to a testicle’s sperm-making ability can begin as early as 12 months of age. That’s why many doctors advise treating an undescended testicle by the time a baby is 1 year old and no later than age 2. Treatment helps lower the chance of infertility. […] Cancer of the testicles. Men who were born with undescended testicles have a higher rate of testicular cancer than other men. But this cancer is rare. It can be cured if found early. If you are a young man who was born with an undescended testicle, talk with your doctor about what you should do.
- #26 Undescended Testicle: Symptoms, Causes, Diagnosis, Treatmenthttps://www.webmd.com/parenting/baby/what-is-an-undescended-testicle
But sometimes, one or both testicles dont fall into place. Thats called an undescended testicle. It can happen to any baby boy, but its more common for those born earlier than expected. […] More often than not, the testicle drops into the scrotum on its own by the time the baby is 6 months old. If it doesnt, the child will likely need surgery. […] The main sign: You cant see or feel the testicle in the scrotum. When both are undescended, the scrotum looks flat and smaller than youd expect it to be. […] An undescended testicle is related to a number of conditions: […] Because sperm need to be a little cooler than the rest of the body, an undescended testicle can cause fertility issues. This is more of a problem when both are lodged in the groin. Early treatment can make a big difference.
- #27 Undescended Testicle: Causes, Treatment and Surgeryhttps://dreminozbek.com/en/undescended-testicle-causes-treatment-and-surgery/
If the operation period is delayed, testicular development cannot be complete and serious problems will arise in the future. The most important of these is the development of testicular cancer and the problem of infertility. […] Orchiopexy surgery reduces the risk of testicular cancer, but does not completely eliminate it. Therefore, these patients should be checked at regular intervals. […] The success rate in orchiopexy surgery is high. It is successful around 95%, complications are extremely low, around 1%.
- #27 Undescended Testicle: Causes, Treatment and Surgeryhttps://dreminozbek.com/en/undescended-testicle-causes-treatment-and-surgery/
Undescended testis (chriptochidism) is the absence of the testicle in the scrotum in boys where it should normally be. It is mostly seen unilaterally and on the right. 10% of both testicles may not be in their normal place. In 3% of term children and 30% of premature children, one or both testicles may not descend normally into the scrotum. […] The most important symptom of an undescended testis is the absence of one or both testicles on palpation. […] If timely measures are not taken, the undescended testis will have serious complications in the future. These complications are: Development of testicular cancer: Testicular cancer is common in men with undescended testicles at advanced ages. The development of cancer in a displaced testis is related to the location of the testis. The higher the testicle, the higher the rate of cancer development. In other words, the rate of cancer development is less in the testicles in a region close to the scrotum. On the other hand, in the case of an undescended testis remaining in the abdomen, cancer development is more likely.
- #28 Undescended testicles – myDr.com.auhttps://mydr.com.au/mens-health/undescended-testicles/
Sometimes the cord that carries semen, blood vessels and nerves becomes twisted, cutting off blood to the testicle. This is a serious condition that requires prompt treatment in order to save the testicle from permanent damage. It is more likely to occur in males who have undescended testicles. […] If the testicles havent descended by 6 months of age they are probably not going to, and treatment is usually required. Undescended testicles are usually treated with surgery. […] Its very important to let boys know that they have had this condition because they have a greater risk of health problems when they are older, such as fertility problems and testicular cancer.
- #29 Understanding Undescended Testicles in Children | Ochsner Healthhttps://blog.ochsner.org/articles/understanding-undescended-testicles-in-children
If the testicle has not descended by the time the baby is six to 12 months old, surgery is usually recommended. The procedure, known as orchiopexy, involves moving the undescended testicle into the scrotum and securing it in place. […] Parents should talk to their doctor if their childs testicle has not descended by six months of age, or if there are any concerns about pain, swelling or changes in the groin area. If surgery is needed, it is important to address the condition before the child is 1 to avoid complications such as infertility or an increased risk of testicular cancer.