The relationship between cerebral palsy and cryptorchidism

Optimal Management of Undescended Testis in Boys with Cerebral Palsy. A Debate

“…The author concluded that UDT may be caused either by sex steroid action directly on the testes or by CNS damage, which in turn causes suppression of pituitary gonadotropins. In 1989, the group of Hutson eventually proposed spasticity of the cremaster muscle leading to pathologic retraction of the testis out of the scrotum in boys with CP [Smith et al, 1989]. The most recent publication from Barthold et al [2018] suggested that cryptorchidism is less common than previously reported in CP (only 26%) with a strong association with quadriplegia.…”

“…However, neither the Management of Undescended Testes: European Association of Urology/European Society for Paediatric Urology Guidelines [Radmayr et al, 2016], nor the Evaluation and Treatment of Cryptorchidism: AUA Guideline [Kolon et al, 2014], the Nordic Consensus on Treatment of Undescended Testes [Ritzen et al, 2007], or the American Academy of Pediatrics Statement on the Timing of Elective Surgery on the Genitalia of Male Children with Particular Reference to the Risks, Benefits, and Psychological Effects of Surgery and Anesthesia [1996] explicitly elaborate on the treatment or timing of surgery in CP. From the very limited data on UDT in CP, there is no reason to assume a different timing in these children [Rundle et al, 1982;Cortada and Kousseff, 1984;Depue, 1988;Smith et al, 1989;Harper et al, 2010] ("Why should testis of a boy with CP be treated differently than in any other boy?"). For example, a nonpalpable testis represents a potentially more dangerous oncologic risk than a testis in a palpable position and laparoscopic/open diagnosis is more justified.…”

Acquired Cryptorchidism: What Should We Know? The Results of a Systematic Review

“…Eardlay et al (Eardley I et al 1994) found that 27% of ascending testes were previously retractile. Smith et al (Smith JA et al 1989) reported an increased secondary ascent of the testes in boys with cerebral palsy, where an increased cremasteric muscle hypertonicity is noted. These findings show that about a third of ascended testes may be passing through a retractile phase through the transition from the scrotum to an extrascotal position (Hack ww et al 2003c).…”

“…Brit J Surg, 90, pp.728-31). The following mechanisms have been proposed to clarify the possible causes of retractile testes to become ascended: a) Smith et al (Smith JA et al 1989), speculated that cremaster muscle spasticity may be a possible cause of acquired UDT in patients with cerebral palsy. However, the proposed etiology in otherwise normal boys is not clear (Barthold JS & González R. 2003), b) The cremaster muscle is androgen sensitive and exhibits decreased activity, resulting in decreased testicular retractility, during periods of high androgen production, specifically in infancy and puberty.…”

The role of the gubernaculum in the descent and undescent of the testis

“…We have proposed that perineal testicular ectopia is caused by abnormal chemotaxis from the GFN [Hutson and Hasthorpe, 2005] Recent studies suggest that acquired cryptorchidism may be common, although this is still not accepted universally [Hack et al 2007;Rabinowitz and Hulbert, 1997]. We proposed some years ago that acquired maldescent was secondary to failure of the spermatic cord to elongate as the boy grows, as the scrotum moves away from the groin with age [Smith et al 1989]. The likely explanation is suboptimal CGRP from the GFN in the perinatal period, leaving the processus vaginalis behind, although often obliterated [Clarnette et al 1997].…”