The testes migrate from the level of the kidneys to the scrotum during embryonic development. If this migration is not completed before birth, the condition is called testicular dystopia. Testicular dystopias can now be treated surgically or hormonally.
What is testicular dystopia?
Testicular dystopias are positional abnormalities of the testicle. In this case, the testicle is temporarily or permanently located outside the scrotum. Testicular dystopia corresponds to either testicular ectopy or undescended testis. In undescended testis, there is incomplete descent of the testis. That is, the testis has not descended completely from the site of formation to its destination. This phenomenon is further differentiated according to the end of migration. In addition to pendulous testis, inguinal testis and sliding testis, cryptorchidism also belongs to this phenomenon. In the case of testicular necropsy, the testis has left the predetermined path in its migration from the site of formation to the destination. Depending on the ultimate location of the testicle, there are penile, femoral, transverse and perineal testinectomy. Approximately three to six percent of newborns suffer from testicular dystopia.
Causes
The testes arise at the level of the kidneys. A common gonadal anlage is their site of origin. Therefore, the testes must travel down through the inguinal canal to the scrotal compartment. In doing so, they move along finger-shaped protrusions in the peritoneum. This migration is also known as testicular descent. Testicular descent begins around the fifth week of pregnancy. Descent is not completed until the seventh month. Once both testicles have reached their destination, it is called a sign of maturity. Premature birth before the seventh month can interrupt the descent of the testicles. In this case, the undescended testicle is only an expression of immaturity and may recede by the actual due date. Another cause may be the use of analgesics during pregnancy. Disorders in hormonal circulation, genetic causes or anatomical obstacles can also be considered as causes of permanent undescended testis.
Symptoms, complaints, and signs
In undescended testis, the testis has migrated along its intended path, but its migration has stopped early. The signs of undescended testis vary with the type of abnormality. For example, in cryptochidism, the testis is located in the abdomen. The inguinal testis corresponds to a testis that has remained in the inguinal canal. The sliding testis has approximately reached its destination, but because of a short spermatic cord it lies in the inguinal canal, from where it can be pushed into the scrotum. The pendulous testis has reached the scrotum but moves out of the scrotum when excited. Unlike the undescended testis, the testis has left the intended path during its migration at testinectomy. Thus, the femoral testis means a testis under the skin of the thigh. The perineal testis is located in the perineal area, the penile testis is displaced to the penile shaft and the transverse testis is located in the scortal compartment of the other side.
Diagnosis and course of the disease
The diagnosis of testicular cytopia can be made on the basis of various examinations. One of the most important examinations is palpation. In some circumstances, an abdominal endoscopy or ultrasound examination may also be useful. Not all testicular dystopias carry the same risk or need to be treated at all. For example, a pendulous testis carries little risk, while other testicular dystopias carry some risk of degeneration. Without appropriate therapy, the risk of a malignant testicular tumor can be up to 32 times higher for affected individuals. Testes remaining in the abdomen, for example, carry the highest risk of degeneration. In addition, testicular dystopia can also endanger fertility. Thus, positional abnormalities of the testes are considered one of the most important causes of impaired fertility.
Complications
Testicular dystopia causes malposition of the testes in the body of the born child. Usually, the position cannot be predicted because the expression of the symptom may vary. However, after birth, surgical interventions can be undertaken to correct the symptoms. In most cases, this does not cause any particular discomfort or complications. The migration of the testicles does not usually cause any particular discomfort for the patient.However, the risk of tumor formation is extremely increased, so that treatment is highly recommended and is carried out in most cases. Furthermore, testicular dystopia can also lead to infertility and thus extremely limit the life of the affected person in adulthood. This can lead to various psychological complaints and complications, so that the affected person not infrequently suffers from depression and reduced self-esteem. The partner may also develop depressive moods. In most cases, the treatment is carried out after the birth and does not lead to complications. In some cases, testicular dystopia also disappears by itself, which is why the doctor usually waits six months after birth to perform the operation.
When should you go to the doctor?
Testicular dystopia is usually diagnosed by the doctor in charge or the obstetrician immediately after birth. Treatment is needed if the undescended testicle does not resolve on its own within a few hours to days. Parents who notice pain or other discomfort in their child should talk to the doctor in charge. If complications develop, such as severe pain or circulatory problems in the scrotum area, the child must be treated in a hospital. In any case, testicular dystopia requires clarification by the pediatrician or a urologist. Otherwise, the malposition can lead to infertility and testicular cancer. Persons diagnosed with testicular dystopia in childhood should also undergo regular urological examinations in adulthood. Close monitoring will ensure that another dysplasia does not develop. If signs of infertility or other disease are already evident, the patient must be evaluated for possible undescended testis and treated if necessary.
Treatment and therapy
No therapeutic steps are usually initiated during the first six months after birth. During this time, physicians wait to see if the testicle may still move into its intended position. If the testicle does not migrate to its position on its own, the descent may be amenable to hormone administration. For four weeks, gonadoliberin is administered as part of hormone therapy. This is followed by three weeks of treatment with β-hCG. Both hormones are usually administered to the infant in the form of a nasal spray. In about 30 percent of cases, this treatment leads to the goal. If hormonal treatment is not successful, the testicle is surgically fixed in the scrotum between the 9th and 18th month of life. This surgical correction is also called orchidopexy. The testicle is fixed at the lowest point of the scrotum in order to exclude a repeated rotation out of the scrotum. The mobility of the testicle is restricted by sutures. The procedure is performed under general anesthesia. In the first step, the surgeon exposes the testicle and in the second step he puts it in position, where he sutures it to the skin layers of the scrotum. After the operation, regular check-ups are indicated to exclude recurrences. Sometimes, after surgery has been performed, hormone therapy is recommended again.
Outlook and prognosis
The prognosis of testicular dystopia can be considered favorable. With today’s medical options and different therapeutic approaches, treatment occurs within the first years of the patient’s life. Testicular anomaly is detected immediately after birth in routine postnatal examinations and diagnosed by imaging in the further course. If there is no spontaneous healing of the testicular dystopia, drug treatment is given after the infant has completed the first six months of life. Worsening of the health condition is not expected within the first months of life. In most cases, the condition remains unchanged. Rather, the organism is given sufficient time for an independent and naturally initiated correction of the testicular positioning to take place. If this does not take place, external possibilities are used to intervene. In many patients, the administration of hormonal preparations already leads to correction and thus to healing of the testicular dystopia. In most cases, this results in lifelong freedom from symptoms.If hormone therapy remains ineffective or does not show the desired success, correction is performed in a surgical procedure. If no further complications occur during or after the operation, the patient is discharged from treatment as cured. This is followed by a follow-up examination after some time so that a relapse can be ruled out.
Prevention
The cause of testicular dystopia has not yet been conclusively determined. Because analgesics may be causative, abstaining from them during pregnancy may prevent testicular dystopia if health permits.
Follow-up
Therapy for testicular dystopia should be completed by the time the child reaches the age of one year. Any subsequent transfer of the testes back into the scrotum carries a higher risk of inability to conceive. If surgery was performed as therapy, direct follow-up in the hospital is initially the responsibility of the physicians. After discharge, the parents must first ensure bed rest and restrain the child’s play behavior during the first week to prevent complications and a renewed undescended testicle. After its surgical relocation, the testicle must first fuse to its new position in the testis in order to be permanently fixed. Until this time, an inconsiderate movement, despite the presence of an internal suture, can lead to a re-displacement. After about seven to ten days, the first follow-up examination is performed to check the position of the testicle and the healing of the wound to date. The attending physician can assess here whether the restriction of movement can already be eased or must be maintained for a further six weeks until the next examination. From then on, quarterly follow-up examinations are performed on average until one year has elapsed. The possibility of a developing testicular tumor persists into adulthood despite surgery and therefore requires continued visits to the urologist until after puberty. If enlargement or induration of the testis occurs, consult the attending physician immediately.
What you can do yourself
Parents who notice signs of testicular dystopia in their child should immediately involve the pediatrician. In some cases, the testicle will move back into position on its own and no further treatment is needed. If medical or surgical treatment is necessary, care must be taken to avoid exposing the child to additional stress and to rest as much as possible. Physical activity should be limited during the first few days to allow the testicle to move back into position or remain in the scrotum after surgery. In case of pain, the doctor may prescribe a mild medicine. Under certain circumstances, remedies from natural medicine are also allowed, for example calendula ointment or preparations with arnica. After an operation, the scrotum should be cooled slightly so that the swelling goes down quickly. Strict hygiene measures can prevent complications such as wound healing disorders or infections. Accompanying medical monitoring of the testicles is necessary. Sometimes testicular dystopia occurs again, which must be recognized as quickly as possible and treated accordingly. It is believed that testicular dystopia can be avoided by avoiding analgesics during pregnancy.
