Not a singular problem

Dear Dr G,

My husband is a 28-year-old man who was born with just one testicle.

Doctors assured his parents the testicle was “lost” along the way out and would find its way back to its rightful place.

Disappointingly, it never found its way home.

The doctor said just one testicle should be good enough for functional purposes.

The missing teticle does not really affect my husband’s life in any way.

He went through an uneventful puberty and all his apparatus seems to be working well.

However, my husband now feels a bit “compromised” as he does not feel like he can perform to his full potential.

We are also both worried about his fertility and the future risk of cancer.

I hope to put Dr G on the spot. What exactly happened to his undescended testicle and how common is it? Do the sufferers encounter any sexual compromises? How does this affect his ability to father a child in the future? More importantly, can this cause cancer?

Regards
Crowning Cameron

An undescended testicle (UDT) is also medically known as cryptorchidism. The term is derived from the Greek word “kryptos” meaning hidden, and “orchis” meaning testicle. During gestation, the male gonads develop at the posterior wall of the abdomen, next to both kidneys. Around seven months of fetal development, the testicle descends from the abdomen, to the inguinal canal, and eventually drops into the rightful place of the scrotal sac. Therefore, an undescended testicle can occur to a child who is born with one or both missing “gems”, which got “lost” along the path of descent.

Cryptorchidism is a relatively common congenital abnormality, affecting either one or both sides of the testicles. As the descent is not complete for a pre-term baby, the condition has a high prevalence of up to 30% amongst premature infant boys. On the other hand, such developmental defects can also be observed in around 3% of full-term babies. 80% of cryptorchid testes will naturally descend by the first year of the child’s life. This is making the overall true incidence of cryptorchidism to be around 1%.

Recent epidemiological data has revealed an increase in the prevalence of cryptorchidism. Apart from the rise in successful nurture of premature babies contributing to the rise in mal descent of testicles, other recognised risk factors also include excessive alcohol consumption during pregnancy, maternal exposure to pesticide and even cosmetics.

Men born with cryptorchidism generally have reduced fertility. However, the reduced sperm count is usually subtle and affected men continue to father children – with or without surgical intervention.

Other complications of undescended testicles also include torsion and trauma.

Testicular torsion is the twisting of the spermatic cord resulting in painful infarction of the gonad. This is ten times more common in undescended testes. Besides, the lost location of the testicles in the groin and inguinal canal is also more susceptible to damage from pressure against pubic bone.

By far, the most feared complication of cryptorchidism is cancer. About one in 500 men born with undescended testes develop testicular cancer, which translates to roughly four to 40-fold increased risk. The peak incidence occurs in the third and fourth decade of life. The closer the lost testicle is to the body, the higher the risk.

The treatment of cryptorchidism in children is usually orchidopexy, which is a procedure to bring the testes back to its rightful place of the scrotal sac. As the condition is rare in adulthood, the removal of the testicle (in other word castration) is instead recommended for adults. This is crucial to reduce the risk of cancer.

To treat cryptorchidism in adults, locating the missing testicle is the key. This can either be done with an ultrasound or MRI scan. Once the missing testicle is located, decision for relocation or removal is made.

Although most men with cryptorchidism live to young adulthood without sexual or fertility compromises, unknown cellular changes can transform a “gem” into a “useless and yet poisonous stone”.

Dr G’s view is that preserving the “missing ball” may just turn out to be a “missing call” in the future due to the increase in the risk of testicular cancer!