What is an undescended testicle? Undescended testis is a condition in which one or both
testes do not lie in the scrotum, the loose bag of skin below the
penis. It is a common condition that occurs in nearly 4% of all
newborn babies.
The testes originally develop in the back of the abdominal cavity
of the foetus. Later they begin to descend to the scrotum. If the
testis fails to descend all the way down and gets stuck somewhere
along the path of descent it is called an undescended testes. This
process of descent occurs during late pregnancy. This is why 30%
of premature babies have at least one undescended testes. Some of
the testes may descend even after birth, but this usually happens
in the first 3-4 months. Testes that do not descend till one year
will not descend and need to be treated.
How is the diagnosis made? The diagnosis is usually apparent. One or both testes
may be missing from the scrotum. The condition, however, needs to
be differentiated from retractile testis. Sometimes the testes
move up and down depending on the temperature of the surroundings.
If the child is in a warm bath his testes are normal, but if he is
exposed to cold or stroked along his upper thigh, the testes move
up towards the abdomen. This up and down movement is normal and
these testes are called retractile testes. They do not require any
treatment.
The paediatric surgeon or urologist will be easily able to
differentiate between a retractile testis and a true undescended
testis. By examining the child he will also be able to locate the
position of the undescended testis. Tests like ultrasound scan or
CT scan to locate the testes are rarely required and are not very
helpful. If the testis is not felt on repeated examination, the
doctor may advise a laparoscopy examination to determine whether
or not the testis is present in the abdomen. Sometimes testes can
reach some place other than scrotum, a condition called ectopic
testes. On examination, it is important to differentiate between
undescended or atrophic testis, in latter condition, the testis is
very small and can be difficult to feel.
Why is treatment needed for undescended testis? It is very important for the boy's psyche to have two
normal testes in the scrotum. This is often an underplayed
argument.
Testes require a temperature slightly lower than the body
temperature for sperm production. If they lie too close to the
body, then over time the cells that produce sperms die leading to
infertility. To minimize this damage undescended testes need to be
brought down to the scrotum by 6 months of age.
Undescended testis are often associated with a hernia which
requires surgical correction.
If the testes remain in the abdomen for a long time, they have a
slightly higher chance of developing a cancer. If testis is in
groin area, it is more easily injured during play or accidents.
What is the treatment? The best treatment for undescended testis is an
operation called orchidopexy. This operation is best done before 6
months of age. It is a safe procedure that is performed under
general anaesthesia. Admission to hospital is usually not
required. A small cut is made in the groin, the testis is freed
from its attachments and its blood supply is preserved. Another
small cut is made in the scrotum and a small pouch is made under
the skin in which the testis is placed. The operation usually
takes about an hour, the child is able to feed shortly thereafter
and can walk about from the same evening.
In some cases, the doctor may prescribe injections of a hormone
called human chorionic gonadotropin (HCG). The role of this is not
defined and may be tried only in some cases where both testes are
undescended.
What if the doctor is not able to feel the testis? There are several possibilities in this case. Either
the testis did not form. Or that it did form but underwent damage
and has become useless. Or it lies somewhere inside the abdomen.
This differentiation is possible by laparoscopy in which a small
telescope is inserted into the child's abdomen under anaesthesia
and the insides are examined to locate the testis. In the first
two cases nothing further needs to be done except removing the
useless testis. If the testis is inside, it will need to be
brought down. In cases where one testis is missing, an artificial
testis may be placed in the scrotum later so that the child does
not suffer from an inferiority complex.
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