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| == Cryptorchidism == | | ===Famous Cases=== |
| {{CMG}}{{AE}}{{MWH}}
| | The following are a few famous cases of narcolepsy: |
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| '''''Synonyms and Keywords:''''' Cryptorchism; maldescended testis; ectopic testis; undescended testicle | | *'''Jimmy Kimmel''', American late-night talk show host, actor, producer, comedian, and writer |
| | *'''Harold M. Ickes''', former deputy White House chief of staff for President Bill Clinton and a leading figure in the His administration's [[healthcare]] reform initiative |
| | *'''Arthur Lowe''', a British actor who played iconic Captain Mainwaring in the British sitcom ''Dad's Army'' |
| | *'''Nastassja Aglaia Kinski''', German actress, and former model |
| | *'''George M. Church''', molecular geneticist, molecular engineer, and chemist, who is a Professor of Genetics and Professor of Health Sciences at Harvard |
| | *'''Teresa Nielsen Hayden''', American science fiction editor, fanzine writer, and essayist who has a famous weblog, named Making Light |
| | *'''Franck Bouyer''', French former road racing cyclist who was unable to compete or train without treatment with Modafinil |
| | *'''Gabe Barham''', former Drummer for American post-hardcore band Sleeping With Sirens |
| | *'''Jinkx Monsoon''' (real name is Jerick Hoffer), Seattle Drag Queen, stage performer, comedian and singer who is the winner of the fifth season of ''RuPaul's Drag Race'' |
| | *'''Aaron Flahavan''', former English (Portsmouth) football Goalkeeper |
| | *'''Paul Gonsalves''', Jazz tenor saxophonist |
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| == Historical Perspective ==
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| '''''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.
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| == Pathophysiology ==
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| The testes begin as an immigration of primordial germ cells into testicular cords along the genital ridge in the abdomen of the early embryo.
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| A testis absent from the normal scrotal position can be:
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| * Found anywhere along the "path of descent" from high in the posterior ([[retroperitoneal]]) abdomen, just below the kidney, to the inguinal ring
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| * Found in the inguinal canal
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| * Ectopic, that is, found to have "wandered" from that path, usually outside the inguinal canal and sometimes even under the skin of the thigh, the perineum, the opposite scrotum, and [[femoral canal]]
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| * Found to be undeveloped (''[[hypoplastic]]'') or severely abnormal (''dysgenetic'')
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| * Found to have vanished (also see Anorchia)
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| About two thirds of cases without other abnormalities are unilateral; 1/3 involve both testes. In 90% of cases an undescended testis can be palpate (felt) in the inguinal canal; in a minority the testis or testes are in the abdomen or nonexistent (truly "hidden").
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| === Associated Conditions ===
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| Cryptorchidism occurs at a much higher rate in a large number of congenital malformation syndromes. Among the more common are:
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| * Cloacal exystrophy
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| * Noonan syndrome
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| * Prader- willi syndrome
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| == Causes ==
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| In most full-term infant boys with cryptorchidism but no other genital abnormalities, a cause cannot be found, making this a common, sporadic, unexplained (idiopathic) birth defect.
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| Rare iatrogenic cases have also been reported in which hernia repair or other surgery in the inguinal area resulted in trapping of a testis above the scrotum.
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| A 2006 study showed that regular alcohol consumption during pregnancy (5 or more drinks per week) is associated with a 3x increase in cryptorchidism, when compared to non-drinking mothers. Other previously known risk factors include exposure to pesticides, low birth weight (including premature birth), gestational diabetes and being a twin.
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| == Epidemiology and Demographics ==
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| Three percent of full-term, newborn infants have cryptorchidism. This decreases to 1% in infants aged six months to 1 year.
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| * The prevalence of cryptorchidism is 30% in premature male neonates.
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| * Seven percent of siblings of boys with undescended testes have cryptorchidism.
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| * In the United States, cryptorchidism ranges from about 3% at birth to 1% from 1 year to adulthood.
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| * Internationally, prevalence ranges from 4% to 5% at birth to about 1% to 1.5% at age three months and 1% to 2.5% at nine months.
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| * Cryptorchidism occurs in approximately 1.5% to 4% of fathers and 6% of brothers of individuals with cryptorchidism.
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| * Heritability in first-degree male relatives is estimated to be approximately 0.5% to 1%.
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| * There may also be an association between cryptorchidism and autism.
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| <ref name="pmid29261861">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume= | issue= | pages= | pmid=29261861 | doi= | pmc= | url= }} </ref>
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| == Risk Factors ==
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| Possible underlying risk factors include:
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| * Premature infants born before the descent of the testicles
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| * Small for gestational age infants
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| * Smaller placental weight
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| * Chemicals endocrine disruptors may interfere with normal fetal hormone balance
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| * Maternal obesity
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| * Maternal diabetes
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| * Maternal exposure to DES
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| * Pesticides
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| * Alcohol consumption during pregnancy (5 or more drinks per week, 3x increase)
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| * Cigarette smoking
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| * Family history
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| * Cosmetics use
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| * Exposure to phthalate (DEHP)
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| * Ibuprofen
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| * Preeclampsia (The more severe the preeclampsia, the greater the risk of cryptorchidism)
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| * Congenital malformation syndromes - Down syndrome, Prader–Willi syndrome, and Noonan syndrome
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| * Persistent Mullerian Duct Syndrome
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| * In vitro fertilization
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| == Diagnosis ==
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| === History and Symptoms ===
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| * There are usually no symptoms, except that the testicle cannot be found in the scrotum (this may be described as an empty scrotum).
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| ==== '''<big>Physical Examination</big>''' ====
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| The most common diagnostic dilemma in otherwise normal boys is distinguishing a retractile testis from a testis that will not/cannot descend spontaneously into the scrotum. Retractile testes are more common than truly undescended testes and do not need to be operated on. In normal males, as the cremaster muscle relaxes or contracts, the testis moves lower or higher ("retracts") in the scrotum. This cremastaric reflex is much more active in infant boys than older men. A retractile testis high in the scrotum can be difficult to distinguish from a position in the lower inguinal canal. Though there are various maneuvers used to do so, such as using a crosslegged position, soaping the examiner's fingers, or examining in a warm bath, the benefit of surgery in these cases can be a matter of clinical judgement.
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| == Treament ==
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| === Medical Therapy ===
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| Hormone treatment does have the occasional incidental benefits of allowing confirmation of Leydig cell responsiveness (proven by a rise of the testosterone by the end of the injections) or inducing additional growth of a small penis (via the testosterone rise). Some surgeons have reported facilitation of surgery, perhaps by enhancing the size, vascularity, or healing of the tissue. A newer hormonal intervention used in Europe is use of GnRH analogs such as nafarelin or buserelin; the success rates and putative mechanism of action are similar to hCG, but some surgeons have combined the two treatments and reported higher descent rates. Limited evidence suggests that germ cell count is slightly better after hormone treatment; whether this translates into better sperm counts and fertility rates at maturity has not been established. The cost of either type of hormone treatment is less than that of surgery and the chance of complications at appropriate doses is minimal. Nevertheless, despite the potential advantages of a trial of hormonal therapy, many surgeons do not consider the success rates high enough to be worth the trouble since the surgery itself is usually simple and uncomplicated.
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| ==== <big>Surgery</big> ====
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| The primary management of cryptorchidism is surgery, called orchidoepxy. It is usually performed in infancy, if inguinal testes have not descended after 4-6 months, often by a pediatric urologist or pediatric surgeon, but in many communities still by a general urologist or surgeon.
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