What is Cryptorchidism?

Cryptorchidism, Undescended Testicle(s) or Undescended Testes is a condition where the testicle(s) fail to descend in the scrotum before birth resulting in an empty scrotal sac. Cryptorchidism can be unilateral (one side) or bilateral (both sides).

What are the complications associated with Cryptorchidism?

Cryptorchidism can result in damage to the testicular tissue and infertility. There is also an increased incidence of testicular cancer in individuals with Cryptorchidism. A detrimental implication of Cryptorchidism is empty scrotal sac. Surgical correction of Cryptorchidism will give your child normal looking male genitals. Testicle(s) in the abdomen are more prone to injury and trauma especially during sports or due to spontaneous torsion. Cryptorchidism is often accompanied with Inguinal Hernia. Terminology Cryptorchidism is derived from the Greek words "crypto" (meaning "hidden") and "orchid" (meaning "testicle"). During the last century, cryptorchidism was sometimes restricted to the subset of undescended testes that were not palpable above the scrotum or in the inguinal canal those that were truly hidden in the abdomen or completely absent. In recent decades the distinction is no longer made in most contexts, and the two terms are used interchangeably. Cryptorchism is an older variant of the same term.

How is Cryptorchidism treated?

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Medical Treatment for Cryptorchidism o Hormonal treatment with Human Chorionic Gonadotrophin (HCG) - This hormone stimulates the Leydig cells to produce male hormone (testosterone) that might result in migration of the Cryptorchidism from the abdomen into the scrotum. Testosterone may also be injected for this purpose. Surgical Treatment for Cryptorchidism o Open Surgery (Orchipexy) - In this procedure, the testes is pulled down into the scrotal sac through the inguinal canal. o Laparoscopic Orchipexy or Orchidopexy - In case where the testes are higher up in the abdomen, Laparoscope is used to pull the testes down into the scrotal sac. Surgical repair is done to:

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1. prevent damage to the undescended testicle by exposure to the higher degree of body heat in the undescended location, thus maintaining future fertility 2. decrease the incidence of tumor formation, which is higher in undescended testicles 3. avoid trauma and torsion 4. prevent the cosmetic and psychologic handicap of an empty scrotum

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Ultrasound. An ultrasound is a noninvasive device that uses sound waves to create images of internal structures of the body. An ultrasound may enable the pediatric urologist to locate a nonpalpable testicle, particularly if it's located within the groin.
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Magnetic resonance imaging (MRI) with a contrast agent. MRI is a technology that uses a magnetic field and radio waves to create images of soft tissues in the body. A contrast agent injected into the bloodstream can improve the imaging capability of the procedure. This procedure may enable your pediatric urologist to locate a testicle in the groin or abdomen. Laparoscopy. This procedure is generally considered the best choice for locating a nonpalpable undescended testicle. Laparoscopy uses a tiny video device connected to a tube that a surgeon inserts through a small incision in your son's abdomen. Images appear and can be enlarged on a video screen. Surgical correction of the undescended testicle may be done during the same procedure. Open surgery. Direct exploration of the abdomen through a larger incision may be necessary in a small number of more complicated cases.

Other diagnostic issues If your infant has two nonpalpable undescended testicles, your doctor may order tests to determine the sex of your child. The "absent" testicles may, for example, be because your child is genetically a female, but has external male genitals. This condition of unclear biological sex is called ambiguous genitalia, or intersex. Tests to check the possibility of ambiguous genitalia include:
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Measurements of various hormone levels in blood and urine Analysis of your baby's sex-related genes Ultrasound investigation for female sex organs (ovaries)

Nursing Diagnoses: Deficient Knowledge related to surgery Impaired Urinary Elimination related to the condition and surgical intervention Disturbed Body Image related to appearance of genitalia Risk for

Infection related to surgical incision and drainage tubes Risk for Deficient Fluid Volume related to surgical losses Acute Pain related to surgical incision and drainage tubes .

Cryptorchidism occurs when one or both testes fail to descend through the inguinal canal and into the srotum. Several processes may slow or arrest testicular descent, including endocrinologic abnormalities affecting the hypothalamic-pituitary-testicular axis, denervation of the genitofemoral nerve, traction of the gubernaculum, abnormal development of the epididymis, or premature birth. Cryptorchid testes are often accompanied by congenital hernias and abnormal testes, and ther are at risk for subsequent torsion. An ectopic testis emerges outside the inguinal ring into the perineum, femoral area, or lies in a transverse scrotal or prepenile location. Anorchia is the complete absence of a testis. Anorchia is suspected whenever one or both testes cannot be palpated in the patient with cryptorchidism. Retractile testes can be found at any level within the path of testicular descent, but they are most commonly identified in the groin. Fortunately, they are not truly cryptorchid; instead, they are introverted to an inguinal or abdominal position because of an overactive cremasteric reflex. The cremasteric reflex, observed as withdrawal of the testis above the srotum and into the inguinal canal in response to various stimuli including exposure to cool temperature, is active during infancy and peaks around age 4 to 5 years. Unlike the cryptorchid testis, the retractile testis can be gently moved into the scrotum without residual tension and does not require treatment. Causes Undescended testes are a congenital problem, meaning they are present at birth. The exact cause is not known, but this problem is believed to be partly inherited, as there is a slightly higher incidence of the condition among relatives of those who have it. There may be some hormonal abnormality associated with the development of undescended testes. Twisting (torsion) of the testes within the abdomen during fetal development may also injure the testes, preventing them from developing appropriately. Risk Factors The following factors increase your childs chance of having undescended testes. - Prematurity - Low birth weight - twin - Down syndrome (fetus)

- Hormonal abnormalities (fetus) - Toxic exposures in the mother - Mother younger than 20 or older than 35 years of age - A family history of undescended testes Clinical manifestations: A nonpalpable testis is typically observed by the parent or detected during routine physical examination by a nurse or physician. If one testis is not palpable, the affected hemiscrotum will appear smaller than the other, while both hemiscrota appear small with bilateral nonplapable testes. In the case of retractile testes, the parents may report intermittently observing the testis in the scrotum, frequently when the child is being bathed in warm water. Nursing considerations: Postoperative care: prevention of infection and instructing parents in home care of the child, including pain control. Infection is prevented by carefully cleansing the operative site of stool and urine. Observation of the wound for complications and activity restriction are discussed. Parents are concerned about the future fertility of the child, and family is counselled regarding the prognosis. In most cases the family can be reassured of normal function in adulthood.