If the testicle in the newborn does not fall, this condition is called cryptorchidism in medicine. It can pass on its own and not cause dangerous consequences, but sometimes pathology leads to problems already in adulthood. Experts recommend not pulling with a trip to the doctor.
What is cryptorchidism, or undescended testis in boys
This condition is characterized by the absence of one or both testicles in boys. You can detect the disease immediately after the birth of the child already at the first examination. When you feel the scrotum, the doctor does not find a testicle in it, it can be located in the abdominal cavity, inguinal zone or genitals.
Cryptorchidism is a common phenomenon. According to statistics, every fourth newborn has signs of this disease, especially premature babies suffer. In children born on time, this pathology is diagnosed in only 4% of cases.
Parents sound the alarm, although doctors say that at first the excitement may not be justified. In most cases, by the age of 6 months of boys' life, the testicle descends into the scrotum on its own. It is extremely rare that you need the help of doctors and surgical intervention.
Etiology of the phenomenon
In the second month of fetal development of the embryo, the laying of sexual gonads occurs. First, the testes form in the abdominal cavity where the lower pole of the kidney is located. In the last trimester of pregnancy, they begin to sink into the inguinal canal through the internal inguinal ring. From here, they advance to the scrotum through the external inguinal ring.
When the testicles fall in newborn boys, this indicates that the pregnancy passes without complications and everything is within normal limits. If the gonad migration in the normal course is suspended, then one or both testicles do not descend into the scrotum.
Why didn’t a testicle fall in a newborn? The reason may be some factors, they are divided into several areas:
- Mechanical. Develop under the influence of such factors: narrowness of the canal in the inguinal part; the scrotum may not have a tunnel; short spermatic cord of the vaginal process of the peritoneum and vessels that feed the testicle; poor development of guide ligaments, etc.
- Endocrine. For this factor, there may be such prerequisites: hormonal disruptions in the body of a pregnant woman; impaired normal functioning of the testicles; problems with the thyroid gland, etc.
- Genetic factor. In this case, the mutation of the GTD gene is most often observed.
Types of Cryptorchidism
If the testicle in the newborn does not fall, then this condition can be divided into two types at the place of localization:
- Abdominal - it is diagnosed when the testicle has not lowered and is in the abdominal region.
- Inguinal - the testicle, when passing the internal inguinal ring, penetrated the groin area and remained there.
Testicular ectopia
Ectopia is a disease in many respects similar to cryptorchidism. The difference is that if the testicle is omitted incorrectly, it does not pass into the scrotum, but into nearby areas:
- groin;
- subcutaneous tissue of the pubis;
- penis root;
- under the skin in the perineum;
- outer femoral surface;
- in the other half of the scrotum.
True and False Cryptorchidism
If we talk about true cryptorchidism, then you should know that the testicle has never been in the scrotum. The following factors influenced this condition:
- scarring;
- fusion of the peritoneum;
- too short vessels of the testicles;
- short duct for excretion of the seed in the spermatic cord.
In this case, by palpating, the doctor will not be able to lower the testicle into the scrotum.
With false cryptorchidism, the testicle can freely move from the inguinal canal to the scrotum and vice versa. This may be affected by:
- increased cremaster reflex ;
- small testicle size and wide inguinal ring.
On examination of the baby, the doctor determines the testicle in the scrotum or in the groin area. By palpation, you can return it to its place. But next time it can rise again in the groin.
If the child is relaxed, then the cremaster relaxes, at which time the testicle moves into the scrotum. If the child is tense, crying or with hypothermia, the testicle returns to the inguinal part. As the baby grows, physiological atrophy of the muscle is observed, which raises the testicle, and false cryptorchidism passes on its own.
The doctor will say why the testicle did not fall in the newborn, in the photo you can see the manifestation of the disease.
Type of "re-raising"
With this type of disease, the testicles, as expected, fall into the scrotum. But due to the insufficient length of the spermatic cords, they are forced to rise again into the inguinal canal or peritoneal region. The condition does not manifest itself for a long time. The boy does not notice the violation, since pain is not felt.
Diagnostics
It is not difficult to determine the presence of pathology; examination and palpation of the baby are sufficient. Neonatologists already identify abnormalities in the delivery room.
Typically, in such cases, the testicle in the newborn does not fall or two testicles at once, and in places of their absence, the scrotum is underdeveloped.
If cryptorchidism is false, then diagnosing it is easy. Palpation is carried out twice: when the baby is at rest and at the moment of tension or cooling.
Experienced parents are able to independently determine the condition by conducting daily hygiene activities. They may notice that the testicle is either in the scrotum or absent.
Regardless of which cryptorchidism (true or false), a small patient should undergo an ultrasound to determine the size of the testicle and its position in the inguinal canal. In addition, you can conduct computed tomography.
If dystrophy, underdevelopment or congenital absence of the testicle in the inguinal canal is observed, then it will be more difficult to diagnose the disease. In this case, laparoscopy is performed, after which an accurate diagnosis is made.
The newborn’s testicles did not fall: what to do?
Therapeutic measures will be carried out according to an individual plan, they must be started immediately after the diagnosis. No need to worry about this, as in 70-75% of babies by the year everything will fall into place.
If the testicle in the newborn does not fall, surgery is also a possible treatment option. Surgical intervention is usually performed after the baby is 1 year old. At this time, it will already be clear whether the testicle will fall on its own or not. It is important to carry out the surgical procedure up to 1.5 years. Before surgery, the child should be constantly watched by a urologist. In some cases, hormonal agents are indicated as adjunctive therapy before surgery.
If the testicle in the newborn does not go down, Komarovsky recommends being constantly examined by a urologist. To speed up the prolapse of the testicle into the scrotum and do without surgery, a course of vitamins and hormones can be prescribed.
Possible complications
The sex glands can develop correctly only in the scrotum, otherwise various complications are observed:
- spermatogenesis is impaired;
- testicular torsion may occur;
- the testicles can become inflamed (traumatic orchitis);
- infringement;
- development of oncology in the testis.
If treatment of cryptorchidism was not carried out on time, then the most common complication is a violation of spermatogenesis. Even if the operation was performed with bilateral undescended testis, the spermatogram is abnormal. Spermatozoa are usually few or many with the wrong structure. Their mobility is reduced.
Such a complication as testicular torsion, in its frequency, occurs in two life periods: from a year to 3 years and from 10 to 15 years. The cause is excessive mobility of the testis and a violation of its fixation.
In some cases, the testicle moves into the inguinal hernia and, together with it, is infringed.
Traumatic orchitis as a complication of cryptorchidism develops due to birth trauma in infants and is called "idiopathic testicular infarction."
Often, these conditions are similar in their symptoms and have a collective name - acute scrotum syndrome.
With an undescended testicle, the risk of developing cancers increases by a factor of 20, and this does not depend on whether treatment has been carried out or not. Therefore, patients who survived cryptorchidism should be constantly registered with a urologist, especially in adolescence and adulthood.
Prognosis for an undescended testicle
At the time of the operation, which was made between 1 and 1.5 years of the baby’s life, a forecast for a successful outcome will be provided. But even in this case, the boy, and in the future man, will need to visit a urologist regularly to prevent the development of various complications.
Testicular pain: causes
If there is pain in the testicles, you should immediately consult a doctor.
When the testicle in the newborn does not fall, the following complications can cause pain:
- torsion of the base of the testicle;
- infringement of it in an inguinal hernia;
- traumatic orchitis;
- inflammatory orchitis.
All these signs are called acute scrotum syndrome. They appear as follows:
- the pain is sharp, gives in the groin;
- the scrotum is swollen and hyperemic on one or both sides;
- testicle enlarged, firm to the touch;
- general temperature may increase, nausea and vomiting are present, the skin is pale, infants refuse food and cry loudly.
Even if the testicle in the newborn does not drop, parents should not worry much, since only in rare cases the disease takes on a serious character. In most cases, by six months, the testicle will have to descend into the scrotum on its own. But at the same time, treating such a condition is not worth negligent either, you need to see a doctor and register because of illness. After all, if you start the disease, then in adulthood, serious problems associated with spermatogenesis and other dangerous complications can arise.