A Undescended testicles (also Maldescensus testis, Testicular dystopia called), denotes one that is not in the scrotum Testicles. The cause of this undesirable development are mostly hormonal Errors during the embryonic phase. Consequence of such a high level can be an increased risk for Testicular tumors and Infertility be.
Right after the birth are approx. 3-6% the newborn boy of one Undescended testicles affected. Since this misalignment can recede spontaneously, at the end of the first year of life only approx. 0.8 to 1.8% of the boys concerned. Since the testes sink in the course of embryonic development and migrate into the scrotum, undescended testicles are also involved Premature babies much more frequently than in full-term babies and has no disease value until the end of the corrected first year of life.
Studies have shown that atrophy of the Leydig cells (testosterone- producing) and the concentration of gonadotropins play an important role in the developmental phase of testicular descent.
At 2-3 months of age, there is usually an increase in gonadotropins and testosterone. This causes a transformation in the testes of gonocytes to adult-dark spermatogonia (adult stem cell pool).Atrophy of these cells leads to a reduced testosterone production and thus to a shifted hormone level. The undescended testicle thus represents an endocrinopathy and can be treated by giving appropriate hormones, among other things.
Forms of misalignment
Of the Undescended testicles can be divided into different forms, depending on the location of the testicle.
- Testicular retention as a form of Undescended testicles : This is the typical "Maldescensus testis". The testicle remains during the descent (28th to 32nd Embryonic week) lie in the scrotum in the inguinal canal.
- Testicular ectopy as a form of Undescended testicles: Here the Testicles when descending not through that Gubernaculum testis given path. Thus, the testicle cannot get into the scrotum, but remains in another place.
- Pendulum testicles as a form of Undescended testicles: The pendulum testicle is a testicle that has migrated normally into the scrotum. However, he can with strong external stimuli and a lively Kremaster reflex temporarily assume a very high position or even a groin position.
- Sliding oden as a form of Undescended testicles: The sliding ode is usually in the area of strip to feel. It can be moved manually into the scrotum, i.e. the actual path for the testicle is clear. However, he slides after the "Let go“Immediately from the scrotum back into the groin and therefore needs one therapy.
The children have no symptoms of undescended testicles as long as the long-term effects have not yet occurred. The only symptom is that it is not palpable or visible Testicleswhich the mother often notices when changing diapers and leads to the doctor. The long-term consequences of undescended testicles are also not directly noticeable. Infertility is only noticed when the affected man wishes to have children. A tumor of the testicle is often painless but only palpable through a thickened testicle. However, the goal should be not to let these consequences arise, but rather the Undescended testicles treat in toddlerhood.
The diagnosis of undescended testicles is usually straightforward, as an empty scrotum can be clearly felt. Such a palpation examination is carried out on all male newborns during the initial check-ups and does not cause any Pain in the testicle. Problems with diagnosing the Sliding- and the Pendulum testicles as in some cases the testicle is palpable. A parents' protocol about the position of the testicles has proven itself here.
A follow-up of the sagging testicle can be done by a regular Ultrasound of the testicle respectively.
Therapy undescended testicles
If treatment of undescended testicles is necessary, it should be completed as best as possible by the end of the second year of life in order to avoid possible secondary diseases. The therapy of the Maldescensus testis usually begins in the first year of life. Up to the end of the first year of life there is often the possibility of a spontaneous decline, which is why there is sometimes even longer waiting until therapy is initiated. For the actual treatment of undescended testicles, there is initially the option of hormone treatment. On the one hand, the infants can be given a hormone-containing nasal spray (LH-RH nasal spray) are applied.
This can be given once a day for 28 days from the 3rd month of life. Alternatively, an intramuscular application of human chorionic gonadotropin (HCG) should be given weekly over a period of 4 weeks. If this hormone treatment does not lead to a descent of the testicle, an operation is necessary, the so-called operative orchidopexy. The testicle is fixed to the scrotum so that it can no longer slip into the inguinal canal. This should take place between the 9th and 18th month of life and be completed by the end of the second year of life. An exception to these therapies is the pendulum testicle. This does not require any therapy if the testicle position predominates.
If the testes are missing due to undescended testicles, testicular implants can also be used. Read more about this at: Testicular Implants - Why Are These So Popular?
At the end of the second year of life, the long-term consequences of an incorrect testicle manifest themselves. This is a decrease in the Spermatogonia number, in addition, the connective tissue in the testicle thickens. If both testicles are affected by an incorrect position, there is a risk for a later one Infertility at 73 to 100%.
This is the reason for the earliest possible therapy before the end of the second year of life. Second, there is the risk of developing one Testicular cancer 5 times higher than with normally developed testicles, approx. 10% of all testicular tumors arise in an incorrectly developed testicle. Decisive factors for a degeneration are the abnormal hormonal level, the cell death in the testes (Testicular atrophy) and the genetic malformation of the testicle (Dysgenesis). Men with an abdominal testicle (in the abdomen) have a four-fold increased risk.
Of the Undescended testicles is a relatively common disease in male infants that can manifest itself in various forms. Here is the Pendulum testicles often does not require therapy, while the other forms of high standing should be treated urgently and early. The undescended testicle is an easily recognizable and easy to treat clinical picture in infancy. However, due to the sometimes fatal consequences of untreated undescended testicles in adulthood, early and successful therapy is essential.
If the therapy is carried out correctly and in good time, the children will not have any consequences or problems afterwards. Nowadays, the undescended testicle operation is also a standardized procedure, which is usually carried out without problems and is also not visually recognizable.