CRYPTORCHIDISM

IntroductionMisplaced testes hidden in the abdomen at birth. Cryptorchidism (undescended testes) is a congenital condition in which a baby boy is born with one or both of his testes not in the scrotum. The testes normally drop down (descend) into the scrotum in the last 1 to 2 months before the boy is born. Many times the testes descend into the scrotum on their own by 2 years of age. If not, surgery should be done to correct the problem. Testes that are not brought down into the scrotum decrease a man’s chances of producing a child, usually because excessive body heat damages sperm production in the testes.

Types of undescended testis1. Cannilicular testis

Here the testicle located above its natural position in the scrotum, body wall prevents normal descent into the scrotum.

2. Intra-abdominal testesHere the testicle is located inside the abdominal cavity residing in a position along its pathway of natural descent. In such a position, it is not amenable to future examination by a physician, & it is at risk of becoming cancerous.

3. Ectopic testicleHere the testicle may be found in regions not in the usual pathway of descent into the scrotum. Five major sites of ectopia are perineum, femoral canal, superficial inguinal pouch, suprapubic area, & contralateral scrotal pouch. The etiology is believed to be misdirected attachment to the scrotum

4. Absent testicleSuch a phenomena of absent testicle can be bilateral (affecting both sides). It is believed to be associated with in utero torsion, vascular insult, or agenesis.

Causes & risk factorsThe exact cause of an undescended testicle isn’t known (idiopathic).

Genetic, maternal health & environmental factors disrupts the hormonePhysical changes & nerve activity

Low birth weight Premature birth Family history of undescended testicle or other problems of genital development Conditions that restrict growth of fetus – down syndrome/abdominal wall defect Alcohol use by mother during pregnancy Cigarette smoking by the mother Obesity in mother Diabetes in mother Parents exposure to some pesticides

Clinical manifestationsTesticles form in the abdomen during fetal development.The testicles gradually leave the abdomen, pass through tube-like passageway in the groin (inguinal canal) & descend into the scrotum.The testicles appear to be either missing or lopsided.

- Non palpable testicle.

Diagnostic evaluationUltrasoundMRILaparoscopyOpen surgery

TreatmentTreatment for Cryptorchidism includes both medical (hormonal) & surgical approach separately or in combination with one another. Procedures are usually completed between 6 & 24 for months of age for the best outcomes.

1. Medical treatment - Increasing the level of the male sex hormone testosterone can increase the likelihood that undescended

testicles will move into the scrotum. This is done by either giving injections of human chorionic gonadotropin (hCG) in doses of 5000 I.U. or gonadotropin releasing analog.

2. Surgical treatment- Orchidopexy

Placement of testis in the scrotum should be accomplished by the age of 5yrs

- Orchidectomy (removal of testis)This surgery is done when the opposite testis is normal & when incompletely descended testis cannot be brought down.

- OrchidoceplioplastyIt involves the abdominal replacement of testis. It is indicated when the other testis has been removed previously & this testis cannot be brought down to the scrotum.

Nursing diagnosis1. Sexual dysfunction related to absence of a testicle2. Anxiety related to surgery3. Knowledge deficit related to disease condition4. Risk of cancer development related to abnormal hormonal production.