Undescended Testis in Boys with Cerebral Palsy

Abstract

Cryptorchidism, or undescended testis, is the most common male reproductive birth defect presenting postnatally or in childhood. The etiology is unknown, but the risk is increased in many syndromic disorders, including cerebral palsy (CP). The frequency has been reported to be 41–54%; however, a recent larger series suggests that 29% of boys with CP have undescended or retractile testes, approximately tenfold greater than the general population. Cryptorchidism risk in CP is independently associated with the severity of spasticity, other congenital anomalies with or without known genetic defects, reduced gestational age, hearing impairment, singleton birth, incontinence, and intrauterine growth restriction (IUGR) but not with brain malformations, hydrocephalus, intellectual disability (ID), gastrostomy use, or vision or speech impairment. The association with spasticity and with presentation later in childhood in this population suggests that an “acquired” presentation is common, possibly due to cremaster muscle spasticity. However, the association with other congenital anomalies suggests that genetic causes may also contribute significantly to co-occurrence of cryptorchidism with CP. In the general population, cryptorchidism is associated with increased risk of subfertility and testicular malignancy, but the level of these risks in the CP population is not defined. Undescended testes are also at higher risk for torsion, which may be difficult to diagnose in patients with ID. Except in high-risk, complex patients, surgical correction is indicated.