Definition of cryptorchidism
Cryptorchidism designates a very frequent pathological picture among infants: it identifies the failure of one or both testicles to descend inside the scrotal bursa, since they are retained in the inguinal canal or inside the abdominal cavity (rarer case), already before of development. As can be guessed, cryptorchidism is a pathological condition that attracts the attention of many pediatricians, urologists, geneticists and oncologists, both for the complexity of the condition itself, and for the consequences that the disease could generate in adulthood. Despite what has been said, cryptorchidism does not seem to represent an important object of study, given the scarce longitudinal studies carried out on cryptorchid subjects, from infancy to adulthood.
Analysis of the term
As with the vast majority of medical terms, cryptorchidism also derives from the Greek: the crypto- κρυπτος (hidden) root and the όρχυς (testicle) ending perfectly anticipate the disease.
Incidence
In light of what emerges from the medical statistics, it seems that criptorchidism is the most frequent anomaly that affects the urogenital apparatus of infants and infants. Furthermore, it is not uncommon for cryptorchidism to occur especially among pre-term newborns (incidence ranging from 9 to 30%); it is also estimated that the disease affects 3-5% of children born within the established term.
In 2000, it is assumed that those born with cryptorchidism were 15, 000-30, 000. In about half of cases, cryptorchidism regresses spontaneously in the first or second year of a child's life; unfortunately, however, the number of children who do not naturally recover is increasing and, if they are not subjected to surgical therapy, they are destined to remain cryptorchids for life. [taken from Il criptorchidismo: physiopathology, clinic, medical and surgical therapy by C. Spinelli].
Furthermore, it appears that cryptorchidism is unilateral in 60-65% of cases (failure of a single testicle, especially the right one), and bilateral in 30-35% (involvement of both testicles).
The incidence of the disease seems to have increased considerably in recent years: due to pollution and alterations affecting estrogen.
Embryogenesis
To understand the real reason that causes cryptorchidism, it is right to take a step back and talk about embryogenesis. The mechanisms that regulate embryonic genesis are very complex, therefore a simplistic summary of testicular localization in physiological conditions is shown below, during development:
- 1st - 8th week: testicular differentiation in the upper lumbar area;
- 8th - 12th week (third month): beginning of the migration of the testicles towards the scrotum (bag in which the testicles are enclosed);
- 3rd month - 7th month: the testicles reach the deep inguinal ring, then reach the inguinal canal;
- 9th month: the testicles are located inside the scrotal sac, thanks to the stimulus given by gonadotropins and androgens (not by chance, to treat pharmacologically criptorchidism, these types of hormones are administered). [taken from The Genetics in the Male Infertility of Salvatore Raimondo, Valerio Ventruto, Andrea Di Luccio]
Classification
Cryptorchidism is differentiated according to the location of the testicle (s) during the descent path: in fact, the cryptorchid testes can be located in the abdominal area (high or low), in the inguinal area or near the soprascrotal or scrotal site high.
Contrary to what one might think, the acquired cryptorchidism exists, although it is a rather rare form: generally, in similar situations, the descent of the testicle can be the consequence of an inguinal hernia.
When the testicles are completely absent in the patient, we no longer speak of cryptorchidism, but of real anorchia.
Based on the location of the testicle, cryptorchidism is distinguished in:
- true cryptorchidism (testicle retained): the medical palpation of the testicle is denied, since this is located near the abdominal cavity;
- ectopic cryptorchidism : as previously analyzed, the testicle is located in an abnormal region, outside the sites normally traveled during the descent;
- cryptorchidism with retractile testicle : occasionally, the testicle returns inside the scrotal bursa: surgical or pharmacological treatments are not indispensable, considering that the testicle can be repositioned inside the scrotal sac through rather simple manual maneuvers;
- cryptorchidism with incomplete testicle descent : the testicle “blocks” itself at the level of the inguinal canal or external inguinal orifice (areas that the testicles travel through during the embryonic stage).
[taken from www.andrologia.it]
In the various types of cryptorchidism, the testicle can be palpable or non-palpable : the latter case represents the less frequent form (8%). The non-palpable testicle generally appears in agnesia, where it is located in the abdomen or inguinal canal; the endo-abdominal testicle is not palpable manually nor detectable by ultrasound along the descending path of the gonad (generally, video-laparoscopy or surgical exploration is used).
[taken from Il criptorchidismo: physiopathology, clinic, medical and surgical therapy by C. Spinelli].
