The testicles migrate from the level of the kidneys into the scrotum during embryonic development. If this migration is not completed before birth, there is talk of testicular dystopia. Testicular dystopias can now be treated surgically or hormonally.
What is testicular dystopia?
According to abbreviationfinder, testicular dystopias are anomalies in the position of the testicles. The testicle lies temporarily or permanently outside the scrotum. Testicular dystopia corresponds to either testicular ectopy or undescended testicles. Undescended testicles are incomplete descent of the testicles. That is, the testicle has not fully descended from the place of formation to its destination. This phenomenon is further differentiated after the end of migration.
In addition to the pendulum testicle, the inguinal testicle and the gliding testicle, cryptorchidism is also part of this phenomenon. In the case of testicle dissection, the testicle has left the specified path during its migration from the place of formation to the place of destination. Depending on the final location of the testicle, there is a penile, femoral, transverse, and perineal testicle dissection. About three to six percent of newborns suffer from testicular dystopia.
The testes arise at the level of the kidneys. A common gonad system is their place of origin. Therefore, the testicles must descend through the inguinal canal to the scrotal compartment. They move along finger-shaped protuberances in the peritoneum. This hike is also known as testicular descent. The descent of the testicles begins around the fifth week of pregnancy. The descent is only completed in the seventh month.
As soon as both testicles have reached their destination, there is a sign of maturity. Preterm birth before the seventh month can disrupt the descent of the testicles. In this case, the undescended testicles are only an expression of immaturity and can recede by the actual date of birth. Another cause can be the use of analgesics during pregnancy.
Disturbances in the hormonal cycle, genetic causes or anatomical obstacles are also possible causes of permanent undescended testicles.
Symptoms, Ailments & Signs
When the testicles are undescended, the testicles have migrated along the intended path, but their migration has come to an early standstill. The signs of undescended testicles differ with the type of abnormality. In cryptochism, for example, the testicles lie in the abdomen. The inguinal testicle corresponds to a testicle that has remained in the inguinal canal.
The gliding testicle has almost reached its destination, but due to a short spermatic cord it is located in the inguinal canal, from where it can be pushed into the scrotum. The pendulum testicle has reached the scrotum but moves out of the scrotum when aroused. In contrast to undescended testicles, the testicles in testicular dissection have left the intended path during their migration.
The femoral testicle means such a testicle under the skin of the thigh. The perineal testicle lies in the perineum, the penile testicle is displaced onto the shaft of the penis, and the transverse testicle lies in the scortal compartment of the other side.
Diagnosis & disease progression
The diagnosis of testicular dytopia can be made using various examinations. One of the most important examinations is palpation. Under certain circumstances, a laparoscopy or an ultrasound examination can also be useful. Not all testicular dystopias carry the same risk or even require treatment.
A pendulum testis, for example, is associated with little risk, while other testicular dystopias are associated with a certain risk of degeneration. Without appropriate therapy, the risk of a malignant testicular tumor can be up to 32 times higher for those affected. Testicles that remain in the abdomen, for example, harbor the highest risk of degeneration. Testicular dystopia can also endanger fertility. Anomalies in the position of the testicles are considered to be one of the most important causes of impaired fertility.
Testicular dystopia causes the testicles to be in the wrong position in the child’s body. As a rule, the position cannot be predicted because the severity of the symptom can vary. After birth, however, surgical interventions can be undertaken to correct the symptoms. In most cases, there are no particular symptoms or complications.
As a rule, the patient does not experience any particular symptoms as a result of the migration of the testicles. However, the risk of developing a tumor increases extremely, 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 those affected in adulthood.
This can lead to various psychological complaints and complications, so that those affected often suffer from depression and reduced self-esteem. The partner can also develop depressive moods. In most cases, treatment takes place after birth and does not lead to complications. In some cases, the testicular dystopia also disappears by itself, which is why the doctor usually waits six months after the birth before the operation.
When should you go to the doctor?
Testicular dystopia is usually diagnosed by the responsible doctor or obstetrician immediately after birth. Treatment is required if the undescended testicles do not go away on their own within a few hours to days. Parents who notice pain or other discomfort in their child should talk to the responsible doctor. If complications such as severe pain or circulatory disorders in the area of the scrotum develop, the child must be treated in a hospital.
Testicular dystopia always requires clarification by a pediatrician or a urologist. Otherwise, the misalignment can lead to infertility and testicular cancer. People who have been diagnosed with testicular dystopia as children should also undergo regular urological examinations as adults. Close monitoring ensures that no further faulty situation develops. If there are already signs of infertility or another disease, the patient must be examined for possible undescended testicles and treated if necessary.
Treatment & Therapy
In the first six months after birth, no therapeutic steps are usually initiated. During this time, the doctors wait to see whether the testicles may still move into the intended position. If the testicles do not move into position on their own, hormones may be used to promote their descent. Gonadoliberin is administered to those affected for four weeks as part of hormone therapy.
This is followed by a three-week treatment with β-hCG. Both hormones are usually given to the infant in the form of a nasal spray. In about 30 percent of cases, this treatment achieves the goal. If the hormonal treatment is not effective, the testicles are surgically fixed in the scrotum between the 9th and 18th month of life. This surgical correction is also known as orchidopexy. The testicle is fixed at the lowest point of the scrotum to prevent it from rotating out of the scrotum again.
The mobility of the testicle is restricted by sutures. The operation is performed under general anesthesia. The surgeon exposes the testicle in the first step and then positions it in the second step, where he sutures it to the layers of skin on the scrotum. After the operation, regular check-ups are indicated to rule out recurrences. Hormone therapy is sometimes recommended after surgery.
Outlook & Forecast
The prognosis of testicular dystopia is favorable. With today’s medical possibilities and different therapeutic approaches, the treatment takes place within the first years of the patient’s life. The anomaly of the testicles is detected immediately after birth in the routine postnatal examinations and subsequently diagnosed by imaging procedures.
If the testicular dystopia does not heal spontaneously, drug treatment is given after the baby has reached the age of six months. A deterioration in the state of health is not to be expected within the first few months of life. The situation usually remains unchanged. Rather, the organism is given sufficient time so that an independent and naturally initiated correction of the testicle positioning can take place.
If this does not take place, external options are used to intervene. The administration of hormonal preparations already leads to a correction and thus healing of the testicular dystopia in many patients. In most cases, this results in a lifelong freedom from symptoms. If the hormone therapy remains ineffective or does not show the desired success, a correction is made in a surgical procedure. If no further complications occur during or after the operation, the patient is discharged from the treatment as cured. After some time, a check-up follows to rule out a relapse.
The cause of testicular dystopia has not yet been finally clarified. Since analgesics can be the cause, avoiding them during pregnancy can prevent testicular dystopia if this is possible for health reasons.
Therapy for testicular dystopia should be completed when the child is one year old. Any subsequent repositioning of the testicles into the scrotum carries a higher risk of infertility. If an operation was performed as therapy, direct follow-up care in the clinic is initially the responsibility of the doctors.
After discharge, the parents must first ensure bed rest and curb the child’s play behavior for the first week in order to prevent complications and undescended testicles again. After its surgical relocation, the testicle must first grow into its new position in the testicle in order to be permanently fixed. Up to this point, a careless movement, despite the presence of an internal seam, can lead to a backward displacement.
After about seven to ten days, the first follow-up examination is carried out to check the position of the testicles and the wound healing that has taken place so far. The doctor treating you can assess whether the restriction of movement can already be relaxed or whether it must be maintained for another six weeks until the next examination. From now on, quarterly follow-up checks will be carried out on average up to the end of the year.
The possibility of a developing testicular tumor persists into adulthood, despite surgery, and therefore requires continued visits to the urologist until after puberty. In the event of enlargement or hardening of the testicles, the doctor treating you should be consulted immediately.
You can do that yourself
Parents who notice signs of testicular dystopia in their child should contact the pediatrician immediately. In some cases, the testicle moves back into position on its own and no further treatment is necessary.
If drug or surgical treatment is necessary, care must be taken to ensure that the child is not exposed to any additional stress and that it takes care of itself as much as possible. Physical movement should be limited in the first few days so that the testicles can move back into position or remain in the scrotum after an operation. For pain, the doctor may prescribe a mild medicine. Under certain circumstances, naturopathic remedies are also permitted, for example marigold ointment or preparations with arnica.
After an operation, the scrotum should be cooled slightly so that the swelling subsides quickly. Strict hygiene measures can prevent complications such as wound healing disorders or infections. In addition, medical monitoring of the testicles is required. Sometimes a 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.