The cryptorchidism is a male genital defect, congenital or acquired, which results in failure of descent of one or both testicles. In the discussion of this article we will focus on root causes and complications that could result.
Fortunately, it is not uncommon that cryptorchidism proves to be a fully reversible phenomenon: in such situations, generally, the testicle back into the scrotal sac after a few months (or within one year) from birth. When, after the first year of life, the child still has cryptorchid testicles, then the disorder takes on all the characteristics to be considered pathological, as a result, medical intervention is essential.
In the light of recent studies aimed at the search for causes that contribute to the manifestation of cryptorchidism, it was found that, in all likelihood, this genital defect is greatly influenced by hormones. More precisely, it is hormone related problems in the hypothalamus and pituitary: the insensitivity of the testis to gonadotropins (with hormones that stimulate the gonads: FSH, LH, hCG) seems to be the main cause of cryptorchidism. Despite the above, the mechanism that regulates the hormonal responsiveness is still an object of study for many authors, since there are no irrefutable proofs. It seems, however, that even testosterone there is implicated.
Furthermore, a particular peptide, known as INSL3, insulin-like factor 3-(insulin-like factor 3,) appears to be the element due to the descent of the testis, precisely during the embryonic stage: it is clear how a genetic alteration of this known factor to be considered, to all intents and purposes, a cause of cryptorchidism.
In addition to the genetic mutation of INSL3, including hypospadias and micropenis could be considered causal elements of cryptorchidism: hypospadias, congenital anomaly caused dall’incompleto development of the urethra, is often associated with cryptorchidism.
The micropenis (condition in which the length of the member is less than 2.5 standard deviations from the norm) seems to be caused by a deficiency of gonadotropins during the fetal stage.
Other etiological factor, guilty of cryptorchidism, the retraction of the gubernaculum testis, scrotal ligament that connects the testicle to the inguinal region, responsible for both the “push” of the gonad to the scrotal sac, and its maintenance within the bag.
Even the testicular dysgenesis syndrome (TDS) may cause cryptorchidism: the TDS seems to be the outcome of embryonic and fetal abnormalities, consequently, in turn, of environmental factors (eg pollution).
The causative factors responsible for acquired cryptorchidism are often controversial, however, these seem to be attributable to surgery for inguinal hernia.
The most immediate complication, as well as more obvious, cryptorchidism, is male infertility in the post-pubertal: when the testicles are not released into the scrotal sac, but held permanently in other forums, infertility is a possibility very likely.
To understand why, it is mandatory to take a step back and talk briefly about the spermatogenesis (maturation and development of male sex cells within the testes) possible due to the stimulation of gonadotropins. To enable the spermatogenesis to complete the maturation of male germ cells, the process requires a certain temperature, which must be lower than that abdominal: it follows that, in the case of testicular retention in the abdomen, the sperm can not survive in semen because of the temperature no longer fit (higher than 1 ° C), so fertility is denied.
Consequently, the fabric seminal is not able to develop at puberty: the damage is irreparable and the fabric is intended seminal irreversible atrophy.
A further complication of cryptorchidism is azoospermia: Some adult males with bilateral cryptorchidism and operated, have a total absence of sperm in the ejaculate. It is understandable, therefore, as cryptorchidism, in some cases, lead to an irreversible sterility total.
However, the statistics interesting facts emerge:
- Patients with bilateral cryptorchidism underwent surgery: 28% had a normal number of sperm in the ejaculate;
- Patients with unilateral cryptorchidism not undergoing surgery: 41% had a normal number of sperm in the ejaculate;
- Patients with unilateral cryptorchidism underwent surgery: 71% had a normal number of sperm in the ejaculate.
Among the most serious complications resulting from cryptorchidism also stands the risk of developing cancer in the testicle does not descend, it is estimated, in fact, that the subjects with cryptorchidism have about 10-20% more likely to develop testicular cancer than thought normal.
Furthermore, it was calculated that the cryptorchid testes abdominal are 4 times more at risk of neoplastic evolution compared to those located in the vicinity of the inguinal canal.
Other complications associated with cryptorchidism, remember inguinal hernia, torsion of the epididymis and testicular anomalies: inguinal hernia was diagnosed in 90% of cryptorchid patients, suggesting a possible influence of ‘ inguinal hernia on cryptorchidism. Still, the torsion of the epididymis, testis ie, shows higher incidence when the size testicular increase (the time that coincides with puberty). Finally, the dissociation of the testicle, testicular agnesia and atresia (absence of the vas deferens, the channels that come from the urethra in the testicles) are three more frequent complications in patients with cryptorchidism.
Last update 2 december 2012