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==Historical Perspective==
==Historical Perspective==
Cryptorchidism is derived from the Greek words "crypto" (meaning "hidden") and "orchid" (meaning "testicle"). During the last century, cryptorchidism was sometimes restricted to the subset of undescended testes that were not palpable above the scrotum or in the inguinal canal — those that were truly hidden in the [[abdomen]] or completely absent. In recent decades the distinction is no longer made in most contexts, and the two terms are used interchangeably. ''Cryptorchism'' is an older variant of the same term.
Cryptorchidism is derived from the Greek words "crypto" (meaning "hidden") and "orchid" (meaning "testicle"). During the last century, cryptorchidism was sometimes restricted to the subset of undescended testes that were not palpable above the scrotum or in the inguinal canal — those that were truly hidden in the [[abdomen]] or completely absent. In recent decades the distinction is no longer made in most contexts, and the two terms are used interchangeably. ''Cryptorchism'' is an older variant of the same term.
 
==Diagnosis==
==Causes==
===History and Symptoms===
In most full-term [[infant]] boys with cryptorchidism but no other genital abnormalities, a cause cannot be found, making this a common, sporadic, unexplained ([[idiopathic]]) birth defect.  
There are usually no symptoms, except that the testicle cannot be found in the scrotum (this may be described as an empty scrotum).
 
===Physical Examination===
Although severely [[prematurity|premature]] infants can be born before descent of testes, there is a strong association of cryptorchidism with low birthweight due to either prematurity or [[intrauterine growth retardation]]. In these infants there is usually no evidence of hormonal malfunction. Associated [[inguinal hernia]]s are common.
The most common diagnostic dilemma in otherwise normal boys is distinguishing a retractile testis from a [[testis]] that will not/cannot descend spontaneously into the [[scrotum]]. Retractile testes are more common than truly undescended testes and do not need to be operated on. In normal males, as the [[cremaster muscle]] relaxes or contracts, the testis moves lower or higher ("retracts") in the scrotum. This [[cremasteric reflex]] is much more active in infant boys than older men. A retractile testis high in the scrotum can be difficult to distinguish from a position in the lower inguinal canal. Though there are various maneuvers used to do so, such as using a crosslegged position, soaping the examiner's fingers, or examining in a warm bath, the benefit of surgery in these cases can be a matter of clinical judgement.
 
Hormonal abnormalities (deficiency or insensitivity to androgens or [[anti-müllerian hormone]]) can be demonstrated in a high proportion of those with evidence of under[[virilization]] or [[ambiguous genitalia|ambiguity]] such as [[hypospadias]] or [[micropenis]].
 
A contributing role of environmental [[chemical]]s — [[endocrine disruptor]]s — that interfere with normal fetal hormone balance has been proposed as well, similar to the effects of [[diethylstilbestrol]] exposure. It is rarely possible to implicate a specific chemical exposure for an individual child.
 
Occasional instances of other genetic defects involving development or function of the [[gubernaculum]] have been reported. [[Homeobox]] [[gene]] [[mutation]]s can cause cryptorchidism in animals but remain a largely theoretical possibility in humans.
 
Rare [[iatrogenic]] cases have also been reported in which hernia repair or other surgery in the inguinal area resulted in trapping of a testis above the scrotum.
 
A 2006 study showed that regular alcohol consumption during pregnancy (5 or more drinks per week) is associated with a 3x increase in cryptorchidism, when compared to non-drinking mothers. Other previously known risk factors include exposure to [[pesticides]], low birth weight (including premature birth), gestational diabetes and being a twin[http://www.sciencenews.org/articles/20070106/food.asp].
 
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}

Revision as of 20:17, 16 April 2013

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Saumya Easaw, M.B.B.S.[2]

Overview

Cryptorchidism is the absence of one or both testes from the scrotum. This usually represents failure of the testis to move, or descend, during fetal development from an abdominal position, through the inguinal canal, into the ipsilateral scrotum. About 3% of full-term and 30% of premature infant boys are born with at least one undescended testis, making cryptorchidism the most common birth defect of male genitalia. However, most testes descend by the first year of life (the majority within three months), making the true incidence of cryptorchidism around 1% overall.

Historical Perspective

Cryptorchidism is derived from the Greek words "crypto" (meaning "hidden") and "orchid" (meaning "testicle"). During the last century, cryptorchidism was sometimes restricted to the subset of undescended testes that were not palpable above the scrotum or in the inguinal canal — those that were truly hidden in the abdomen or completely absent. In recent decades the distinction is no longer made in most contexts, and the two terms are used interchangeably. Cryptorchism is an older variant of the same term.

Diagnosis

History and Symptoms

There are usually no symptoms, except that the testicle cannot be found in the scrotum (this may be described as an empty scrotum).

Physical Examination

The most common diagnostic dilemma in otherwise normal boys is distinguishing a retractile testis from a testis that will not/cannot descend spontaneously into the scrotum. Retractile testes are more common than truly undescended testes and do not need to be operated on. In normal males, as the cremaster muscle relaxes or contracts, the testis moves lower or higher ("retracts") in the scrotum. This cremasteric reflex is much more active in infant boys than older men. A retractile testis high in the scrotum can be difficult to distinguish from a position in the lower inguinal canal. Though there are various maneuvers used to do so, such as using a crosslegged position, soaping the examiner's fingers, or examining in a warm bath, the benefit of surgery in these cases can be a matter of clinical judgement.

References

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