UNDESCENDED TESTIS
What is Undescended Testis?
Undescended testis (also known as cryptorchidism) is a condition in which one or both of a baby boy's testes have not moved down into their proper place in the scrotum.
How Does it Happen?
As a baby boy grows inside his mother's womb, his testes form inside his abdomen and move down (descend) into the scrotum shortly before birth. But in some cases, that move doesn't happen, and the baby is born with one or both testicles undescended. The majority of cases are in babies born prematurely.
Undescended testes move down on their own in about half of these babies by the time they're 6 months old. If they don't, it's important to get treatment. The testes make and store sperm, and if they don't descend they could become damaged. This could affect fertility later in life or lead to other medical problems.
How to Diagnose?
Doctors usually diagnose cryptorchidism during a physical exam at birth or at a check-up shortly after. Most undescended testes can be located or "palpated" on exam by the doctor.
In a few boys, the testis may not be where it can be located or palpated, and may appear to be missing. In some of these cases, the testis could be inside the abdomen.
Some boys may have retractile testes. This is a normal condition in which the testes can appear to be outside of the scrotum from time to time, raising the concern of an undescended testis. The testes usually are in the scrotum, but sometimes temporarily pull back up into the groin. A retractile testis doesn't require treatment because it's a normal condition. But a Paediatric surgeon might need to do an exam to distinguish it from an undescended testis.
Treatment
If a testis has not descended on its own by the time a baby is 6 months old, he should be checked by a Paediatric surgeon and have treatment if the condition is confirmed. This usually involves surgically repositioning the testis into the scrotum.
Treatment is necessary for several reasons:
- Being up in the body means the undescended testicle is at a higher temperature than usual (testes need to be below regular body temperature to produce sperm). The higher temperature may harm the development of testis and its ability to make sperm in the future. This could possibly lead to infertility (the inability to father children).
- An undescended testis is more likely to form a tumour than a normally descended testis.
- The undescended testis may be more at risk for injury or testicular torsion.
- An asymmetrical or empty scrotum can cause a boy worry and embarrassment.
- Sometimes boys with undescended testes develop inguinal hernias.
If surgery is done, it's likely to be an orchidopexy.
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A) Single Scrotal Incision Orchidopexy (SSIO)
Depending on the location of the undescended testis an incision is made on the scrotum and the testicle is brought down through this incision only for orchidopexy. It leaves hardly visible scar later on.
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B) Inguinal incision
In this procedure, a small cut is made in the groin and the testis is brought down into the scrotum, then fixed (or "pexed") in place. Doctors usually do this on an outpatient basis (with no overnight stay in the hospital), and most boys recover fully within a week.
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C) Laparoscopy assisted Orchidopexy
In those children where the testes are inside the abdomen the laparoscopy assisted orchidopexy is the procedure of choice. Laparoscopy assisted orchidopexy can be single or double stage procedure depending on the age and the location of testis inside the abdomen.
Most doctors believe that boys who've had a single undescended testis will have normal fertility and testicular function as adults, while those who've had two undescended testes might be more likely to have reduced fertility.
Boys who've had undescended testes should have regular follow-up appointments with your Paediatric Surgeon to make sure that no problems develop.
All boys — even those whose testes have properly descended — should learn how to do a testicular self-exam when they're teens so that they can find any lumps or bumps that might be early signs of medical problems.