Cryptorchidism

Cryptorchidism

1. Cryptorchidism Introduction Cryptorchidism is derived from the G reek word meaning that- Crypto – hidden and orchid - testicle. It is most common birth defect of the male genitalia. About 3% of full term and 30% of premature infants 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 ).

2. Definition Cryptorchidism is the failure of one or both testes to reach the normal position in the scrotal sac through the inguinal canal . Cryptorchidism is the absence of one or both testes from the scrotum.

3. Types Retractile or pseudo cryptorchidism: > A retractile testicle descend into the scrotum but pull back into the inguinal canal because of a hyperactive cremasteric reflex. In this type the testicles can be placed in the scrotum manually and stay there for a short period of time. Palpable (80%): >In this type, (also called prepubic or inguinal) the testicle is located anywhere from just above the scrotum to high in the groin.

4. Cont…. Nonpalpable (15 %): >This means the testicle is in the boy’s abdomen or is absent and  not felt in the scrotum or inguinal canal. Ectopic (5%): >In this case, the testicle has taken the wrong path and ended in an unusual location in the groin area.

5.   Etiological factors The exact cause of an undescended testicle is not known. A combination of genetics, Maternal health Environmental factors might disrupt the hormones, Physical changes Nerve activity that influence the development of the testicles .

6. Cont…. Impairment of the hypothalamic pituitary gonadal axis: block in the hormonal axis to stimulate the testes to descend or the testes may fail to respond the stimulus due to some inherent defects. Anatomical obstruction: there may be an obstruction in the pathway of descend or failure of intra abdominal pressure to rise. Heredity or chromosomal anomalies: absence of one or both testes. Short spermatic cord and artery mechanically prevent the descend. Ectopic attachment of the testes.

7. Risk Factors Factors that might increase the risk of undescended testicle in a newborn include: Low birth weight Premature birth Family history of undescended testicle or other problems of genital development Conditions of the fetus that can restrict growth, such as Down syndrome or an abdominal wall defect Alcohol use by the mother during pregnancy. Cigarette smoking by the mother or exposure to secondhand smoke Obesity in the mother Diabetes in the mother — type 1 diabetes, type 2 diabetes or gestational diabetes Parents' exposure to some pesticides

8. Pathogenesis The process of testicular descent is regulated by an interaction between hormonal and mechanical factors. The testis develops at 7–8 wk of gestation. At 10–11 wk, the Leyding cells produce testosterone, which stimulates differentiation of the wolffian (mesonephric) duct into the epididymis, vas deferens, seminal vesicle, and ejaculatory duct. At 32–36 wk, the testis, which is anchored at the internal inguinal ring by the gubernaculum, begins its process of descent. The gubernaculum distends the inguinal canal and guides the testis into the scrotum.

9. Clinical features A non palpable testis (unable to feel on examination) is the most common symptom of cryptorchidism. However, each child may experience symptoms differently. Symptoms of cryptorchidism may resemble other conditions or medical problems. 

10. Diagnostic measures Soon after the baby is born or during a routine check-up when they are six to eight weeks old. Physical examination The first stage in diagnosing undescended testicles is to carry out a physical examination to see whether the testicles can be felt near the scrotum (palpable) or if they cannot be felt at all ( unpalpable ).

11. Further tests: Ultrasound scan, CT scan, Diagnostic laparoscopy Hormonal assay Urine and   Blood tests .

12. Medical management In most cases, the testicle will descend without treatment during the child’s first year. If this does not occur, treatment may include: Hormone injections (B-HCG or testosterone) to try to bring the testicle into the scrotum. It also helps in the enlargement of the testis. Surgery ( orchiopexy ) to bring the testicle into the scrotum. This is the main treatment. If there is an associated hernia, the herniotomy along with orchidoplexy is indicated.

13. Complications In order for testicles to develop and function normally, they need to be slightly cooler than normal body temperature. The scrotum provides this cooler environment. Until a boy is 3 or 4 years old, the testicles continue to undergo changes that affect how well they function later.

14. Complications of a testicle not being located where it is supposed to be include: Testicular cancer Fertility problems Other complications related to the abnormal location of the undescended testicle include: Testicular torsion. Trauma Inguinal hernia.   

15. Nursing Diagnosis Fever r/t infection. Deficient Knowledge related to surgery. Impaired Urinary Elimination related to the condition and surgical intervention. Disturbed Body Image related to appearance of genitalia Risk. 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 .