Cryptorchidism is the failure of one or both testes to descend into the scrotum. It occurs in approximately 3% of full term and 30% of premature baby boys. There are several types including retractile, palpable, nonpalpable, and ectopic. Risk factors include low birth weight, prematurity, family history, and maternal health conditions. Diagnosis involves physical examination and may include ultrasound, CT scan, or laparoscopy. Treatment is usually hormone therapy or surgery to bring the testes into the scrotum, helping them develop properly and reducing cancer risks.

1. Cryptorchidism
Introduction
 Cryptorchidism is derived from the Greek word meaning that-
Crypto – hidden and
orchid - testicle.
 It is most common birth defect of the male genitalia.
 About 3% of full term and 30% of premature infants boys are born
with at least one undescended testis.
 However , about 80% of cryptorchid testes descend by the first year
of life ( the majority within three months ).

2. Definition
Cryptorchidism is the failure of one or both
testes to reach the normal position in the
scrotal sac through the inguinal canal.
Cryptorchidism is the absence of one or both
testes from the scrotum.

4. Types
 Retractile or pseudo cryptorchidism:
> A retractile testicle descend into the scrotum but pull back into the
inguinal canal because of a hyperactive cremasteric reflex.
 In this type the testicles can be placed in the scrotum manually and stay
there for a short period of time.
 Palpable (80%):
>In this type, (also called prepubic or inguinal) the testicle is located
anywhere from just above the scrotum to high in the groin.

5. Cont….
 Nonpalpable (15%):
>This means the testicle is in the boy’s abdomen or is absent and not felt
in the scrotum or inguinal canal.
 Ectopic (5%):
>In this case, the testicle has taken the wrong path and ended in an
unusual location in the groin area.

7. Etiological factors
 The exact cause of an undescended testicle is not known.
 A combination of genetics,
 Maternal health
 Environmental factors might disrupt the hormones,
 Physical changes
 Nerve activity that influence the development of the
testicles.

8. Cont….
 Impairment of the hypothalamic pituitary gonadal axis:
block in the hormonal axis to stimulate the testes to
descend or the testes may fail to respond the stimulus
due to some inherent defects.
 Anatomical obstruction: there may be an obstruction in
the pathway of descend or failure of intra abdominal
pressure to rise.
 Heredity or chromosomal anomalies: absence of one or
both testes.
 Short spermatic cord and artery mechanically prevent
the descend.
 Ectopic attachment of the testes.

9. Risk Factors
Factors that might increase the risk of undescended testicle in a newborn
include:
 Low birth weight
 Premature birth
 Family history of undescended testicle or other problems of genital
development
 Conditions of the fetus that can restrict growth, such as Down syndrome or an
abdominal wall defect
 Alcohol use by the mother during pregnancy.
 Cigarette smoking by the mother or exposure to secondhand smoke
 Obesity in the mother
 Diabetes in the mother — type 1 diabetes, type 2 diabetes or gestational
diabetes
 Parents' exposure to some pesticides

10. Pathogenesis
 The process of testicular descent is regulated by an interaction
between hormonal and mechanical factors.
 The testis develops at 7–8 wk of gestation. At 10–11 wk, the Leyding
cells produce testosterone, which stimulates differentiation of the
wolffian (mesonephric) duct into the epididymis, vas deferens,
seminal vesicle, and ejaculatory duct.
 At 32–36 wk, the testis, which is anchored at the internal inguinal
ring by the gubernaculum, begins its process of descent.
 The gubernaculum distends the inguinal canal and guides the testis
into the scrotum.

12. Clinical features
 A non palpable testis (unable to feel on examination) is the most
common symptom of cryptorchidism.
 However, each child may experience symptoms differently.
 Symptoms of cryptorchidism may resemble other conditions or
medical problems.

13. Diagnostic measures
 Soon after the baby is born or during a routine check-up when they
are six to eight weeks old.
 Physical examination
 The first stage in diagnosing undescended testicles is to carry out a
physical examination to see whether the testicles can be felt near
the scrotum (palpable) or if they cannot be felt at all (unpalpable).

14. Further tests:
 Ultrasound scan,
 CT scan,
 Diagnostic laparoscopy
 Hormonal assay
 Urine and
 Blood tests.

15. Medical management
 In most cases, the testicle will descend without treatment during the
child’s first year. If this does not occur, treatment may include:
 Hormone injections (B-HCG or testosterone) to try to bring the
testicle into the scrotum. It also helps in the enlargement of the
testis.
 Surgery (orchiopexy) to bring the testicle into the scrotum. This is
the main treatment. If there is an associated hernia, the herniotomy
along with orchidoplexy is indicated.

16. Complications
 In order for testicles to develop and function normally, they
need to be slightly cooler than normal body temperature.
 The scrotum provides this cooler environment.
 Until a boy is 3 or 4 years old, the testicles continue to
undergo changes that affect how well they function later.

17. Complications of a testicle not being located where it is supposed to
be include:
 Testicular cancer
 Fertility problems
Other complications related to the abnormal location of the
undescended testicle include:
 Testicular torsion.
 Trauma
 Inguinal hernia.

18. Nursing Diagnosis
 Fever r/t infection.
 Deficient Knowledge related to surgery.
 Impaired Urinary Elimination related to the condition and surgical
intervention.
 Disturbed Body Image related to appearance of genitalia Risk.
 Infection related to surgical incision and drainage tubes.
 Risk for Deficient Fluid Volume related to surgical losses.
 Acute Pain related to surgical incision and drainage tubes .