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Undescended Testicles

The undescended testis is a mostly congenital, incorrect location of one or both testicles. The testicle is then not permanently in the scrotum, but in the inguinal canal or abdominal cavity. Because this increases the risk of subsequent testicular tumors and infertility, one should correct the wrong position of the testis in the first year of life.

Testicle Elevation: Description

At an undescended testicle (Maldescensus testis), at least one testicle is not in its natural position in the scrotum (scrotum), but in the inguinal canal or lower abdominal cavity.

Most of the time it is a congenital phenomenon (primary undescended testicles). In children, the misconception already occurs immediately after birth. Only in rare cases, a testicle is initially in the correct position and only later assumes a wrong position (secondary testicle elevation).

How is an undescended testicle created?

In the unborn child, the testes develop in the abdominal cavity at the level of the upper lumbar vertebrae. In the course of pregnancy they migrate first to the edge of the pelvis and from there from the seventh month of pregnancy on the inguinal canal in the scrotum.

The testicles are not isolated in the scrotum, but are attached to the spermatic cord (Funiculus spermaticus). It is a bundle of vessels, nerve fibers and the vas deferens, which pulls from the testicles through the inguinal canal into the abdomen.

The "migration" of the testicle towards the scrotum in the embryonic period is called descensus testis. For a normal duration of pregnancy, both testes should reach the scrotum until birth.

Various factors can hamper complete testicular descent. One speaks then of a Maldescensus testis. Depending on the height of his hike, the descent stops, the affected testes remain either in the abdominal cavity or in the inguinal canal. It is therefore higher than normal, hence the term "undescended testicles (cryptorchidism)".

In a secondary undescended testicles, the testes return to the inguinal canal or even the abdomen, after he was initially in the scrotum. This happens, for example, through growth disorders or scarring after certain operations.

Which forms of undescended testicles exist?

Depending on the location of the affected testicle, there are basically three different variants of undescended testicles:

  • Abdominal testicles (abdominal retention): In this form, the migration of the testis has already stopped in the abdomen.
  • Inguinal testicles (retention testis inguinalis): The testes are located in the area of ​​the inguinal canal and can not be displaced into the scrotum. This is the most common form of undescended testicles.
  • Sliding testes (retention testis prescrotalis): The testes are located in the lowest part of the inguinal canal, just above the scrotum. Although it is possible to push the gliding odor gently into the scrotum, it then slides back to its original position because the spermatic cord is too short.

Pendelum testicels: Although the testicle lies in the scrotum, it is drawn into the inguinal canal by reflex-like tension of a muscle running in the spermatic cord, the cremaster muscle. For example, cold, stress or sexual arousal triggers the Kremaster reflex.

Unlike the aforementioned forms of undescended testicles, a pendulum testis is not pathological and does not cause any complications. He therefore does not need to be treated.

In connection with an undescended testicle is sometimes also referred to as a so-called cryptorchidism. These two terms do not mean the same thing. Also, the cryptorchidism is not a variant of the undescended testicles.

"Cryptorchidism" is just a generic term for not being able to feel a testicle. This is true for an abdominal testicle, but also if a testicle is not created (testicular agenesis). In the same way, it can also lie in other places, outside of the abdomen and inguinal canal (testicular ectopia) and therefore can not be felt.

How common is the undescended testicle?

Testicular upleg is the most common congenital malformation of the genitals. In about one to three percent of premature babies, at least one testicle does not descend to the scrotum. Among preterm infants, the proportion is even higher at 30 percent. In about 1.5 percent of the boys develop a secondary testicular elevation after birth.

Testicle elevation: symptoms

At first, most of the time, there are no immediate symptoms due to an undescended testicle. However, if timely treatment is not provided, serious complications may sometimes occur later.

Symptoms of undescended testicles: baby and child

Babies and children with undescended testicles usually have no direct symptoms, such as pain or hormonal imbalances. The affected testicles are not correct, but are normally trained.

In adolescence, however, it can become a psychological burden with increasing sexual awareness when one or both testicles are not in the scrotum. But as a rule, an undescended testicle is treated before the first birthday, so it usually comes not at all.

Complications of undescended testicles: Adult male

Even if a therapy was given early, a past undescended testis can lead to complications in the course. These are usually noticeable only in adulthood.

Testicular rotation

In some cases, the false position of the testes favors a testicular torsion, ie rotation of the testicle on the spermatic cord. This laces the vessels that feed the testicles. If the torsion is not treated very quickly, the testicle dies.

Hernia

In addition, inguinal and gliding hernias sometimes develop weak spots in the inguinal canal, through which intestines can break in from the abdominal cavity. It then protrudes a so-called hernia bag with intestinal components in the inguinal canal. Such a hernia (inguinal hernia) is usually noticeable as a painless swelling in the groin. However, it should be treated soon to prevent the intestinal circulation from being disturbed.

Infertility

An undescended testicle can affect fertility. If only one testicle is affected, this hardly matters, but men with a two-sided Maldescensus testis produce significantly fewer children.

Testicular cancer

The development of testicular tumors is also favored by an undescended testicle. In the man with an operated maldescensus testis, the risk of testicular cancer increases three to eight times over that of men with normal testes. Without therapy, the risk is even more than 30 times higher.

Why do complications arise in undescended testicles?

On the one hand, undescended testicles are associated with increased risks of infertility and testicular cancer from the beginning. In the case of patients, the wrongly positioned and even the correctly positioned testes are fundamentally more at risk of developing complications later in the course (primary damage).

In addition, a permanently elevated ambient temperature additionally damages the testes (secondary damage). While in the scrotum namely a temperature of about 33 degrees Celsius, it is in the inguinal canal or abdominal cavity two to four degrees warmer.

The higher the temperature and the longer the testicle is exposed to it, the more the risk of long-term consequences increases. Correspondingly, in connection with abdominal testes, complications are more often encountered than with inguinal canes or gliding hives, because it is warmer in the abdominal cavity than in the inguinal canal.

Testicles undescended: disease course and prognosis

In most cases, one must operate on boys with a testicle elevation, because the high testicles rarely go down after birth without therapy. Only seven percent of all patients do so within the first year of life, after which it becomes increasingly unlikely.

Timely treatment reduces the risk of potential complications of undescended testicles. Consequences such as infertility and tumors are much less likely to occur than when the testes are transferred to the scrotum for years or not at all. Nevertheless, patients must always be aware of changes in the testicles. Even if one corrects the undescended testicles within the first year of life, there is a life-long increased risk of developing testicular cancer. Most testicular tumors occur between the ages of 20 and 40 years. Typical signs are painless size and consistency changes in the testicles. Boys who once had an undescended testicle, should learn early on to pay attention to such signs and thus to go to a doctor. The earlier you recognize testicular cancer, the better the chances of recovery.

Undescended testicles

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MD Claus F. Fieseler

MD Claus F. Fieseler
Head of the Urology and Nephrology Department

MD Eberhard Köhler

MD Eberhard Köhler
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MD Carsten Sippel

MD Carsten Sippel
Head physician assistant

Prof MD Wilhelm Esser-Bartels

Prof MD Wilhelm Esser-Bartels
Head physician assistant

MD Christina Schmitt

MD Christina Schmitt
Senior physician

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