Cause
For a malfunction of the testis – or cryptorchidism – a maldevelopment in embryonic maturation is responsible. During the 28th to 32nd week of pregnancy, the testis on both sides usually begins its descent from the abdominal cavity into the scrotum. The abdominal cavity represents its original site of attachment.
During fetal and embryonic development, the body grows and stretches, so that various organs – such as the testicles – must “correct” their position. The descent of the testes is therefore a completely natural process, but it can lead to problems for a variety of reasons. If the testicle has not descended completely by the end of the 32nd week of pregnancy, there is no immediate need for treatment.
Descending can take place until the end of the second year of life. The therapy of cryptorchidism should generally be completed by the end of the second year of life. This point in time is seen as the crossroads for the further functionality of the testis.
If cryptorchidism persists after the second year of life, tumorous degeneration and infertility are likely. Until this time, however, it can still be waited to see whether the testis descends on its own.If the testicle is palpable in its “wrong place”, therapy can also be performed after the third month of life. A pendulum testis – i.e. a testis that only shifts in the direction of the inguinal canal during sexual arousal – does not need to be treated as long as it is normally located in the scrotum.
In contrast to the sliding testis, which can be moved between the inguinal canal and the scrotum, no reduced fertility is to be expected with a pendulum testis. For all other forms of undescended testicles or cryptorchidism, therapy is indicated. This consists primarily of hormone therapy with GnRH.
GnRH is an abbreviation for gonadotropin relasing hormone, i.e. a hormone which releases another hormone – namely gonadotropin. Gonadotropin, in turn, is responsible for the sexual development of male (and female) gonads, thus promoting growth, weight, and the descent of the testes into the scrotum. This is a relatively complicated mechanism, but in a good third of cases it leads relatively elegantly to the descent of the testis into the scrotum in a four-week treatment.
Elegant because the GnRH can be easily applied as a nasal spray and no surgery is necessary. However, if this hormone therapy is not successful, the testicle must be surgically fixed in the scrotum by the age of 18 months. This procedure is also called “orchidopexy”.
Hormone therapy is contraindicated in all forms of testicular ectopia. In testicular ectopia, the problem is not an undescended testicle, which could be treated by the addition of sex hormones. Rather, the testicle has descended far enough, but has come to rest in the wrong place. In this case, administration of GnRH would promote further growth on the perineum, the limb or – depending on the shape – the thigh. In these cases, surgery is the method of choice.
