Monorchism is a condition in which a male has only one testicle. It can have a wide number of causes. This condition can be a consequence of disturbed embryonic or fetal development, or one testicle may be lost later in life for a variety of reasons. Here we discuss some of the most common causes of monorchism.
Cryptorchidism or an undescended testicle is a very common condition among young children. It has its origin in fetal development. The testicles are normally developed in the abdominal cavity during the embryonic period by the 10th week of gestation. They do not start moving towards the scrotum until the 28th week, however. From the 28th to the 40th week, it is expected that the testicles enter the inguinal canals on both sides and gradually descend to the scrotum. However, a great number of newborns have one or both testicles undescended at birth, but in more than 60 percent of them the testicles descend spontaneously by the end of the first year. If the problem remains, it is very unlikely that the testicles will descend spontaneously during childhood.
The treatment of choice for cryptorchidism is a surgical procedure called orchiopexy. Hormonal therapy can be tried in mild cases, but it is often unsuccessful. Consequences of inadequate treatment can be very bad. Namely, the temperature in the abdominal cavity and inguinal canal is different from the temperature in the scrotal sac, and it can jeopardize the function of the testicles, causing infertility.
It is very important to perform the orchiopexy procedure during the first year of life in order to avoid loss of testicular function and infertility.
During embryonic and fetal development, different problems with testicles can occur. They are undetectable and untreatable before birth. These include testicular torsion, injury, and hormonal imbalance, and they can lead to testicular regression syndrome (TRS) which is also called "vanishing testis". In this condition, the immune system recognizes that the testis is damaged and activates the cells called macrophages to resorb and eliminate the non-functional organ. Finding of absence of one testis from both inguinal canal and scrotum is usually a result of TRS.
Although TRS cannot be treated, it is important to perform a detailed examination in order to eliminate possibly treatable conditions, such as cryptorchidism.
Orchiectomy is a surgical procedure during which one or both testicles are removed due to some pathological process. Indications for orchiectomy include invasive testicular tumors, serious injuries, untreated testicular torsion, and prostatic cancer. Besides radical orchiectomy in which the whole testicle is removed, it is sometimes possible to perform surgical procedures to eliminate the pathological process and partially save testicular function.
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