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Pediatric – Undescended Testis

What is an undescended testicle?

Testicles develop in the male fetus normally during pregnancy. In the early stages, testicles are located in the lower abdomen. Just before birth, in normal conditions, the testicles begin their journey down and move into the scrotum. In case one of the testicle fails to move down to the scrotum then it is termed as undescended testicle. In rare cases, both the testicles fail to descend into the scrotum.

Approximately 5 out of 100 baby boys are said to be born with undescended testicle. This is also seen in premature babies or babies with abnormally small size.

There is no common consensus as to what causes this condition however it is seen to be hereditary in some cases.

Normally, both testicles are placed inside the scrotum by the time the baby is 3 months old. In case the testicles do not descend even at the age of 6 months, then it is advised to seek a doctor’s advice.


What are the symptoms?

An undescended testicle is asymptomatic and does not cause pain. Te scrotum may seem smooth or less developed on one side or the side without the testicle seems flat and smaller in comparison. The testicle is not felt under physical examination on one side.


How can an undescended testicle be diagnosed?

At regular post-childbirth visits to the doctor, the doctor may feel the baby’s scrotum to check if:

  • Testicle can be felt while it is absent in the scrotum. This physical examination may also be scheduled when the baby is between 3 to 6 months old. By this time, the testicle may move into its normal position in the scrotum.

  • The testicle is still inside the lower abdomen or it is too small to be felt or is absent altogether. A laparoscopic (minimally invasive) surgery is normally advised to find the testicle.

  • Both testicles are undescended and cannot be felt in the groin. The doctor may advise blood hormone test to check whether the testicle is present. However, both testicles being absent is very rare.

Retractile testicles or ectopic testicles are also known to cause similar findings. These conditions make the testicles placed in abnormal position in the scrotum or groin. The doctor will advise on the proper diagnostic tests and treatment methods for individual conditions.


How is it treated?

Normally, doctors recommend observation in case this condition is suspected in new-born babies. In case the testicles have not dropped at 6 months of age, the doctor may recommend surgical treatment, Orchidopexy/orchiopexy) at around 9 to 15 months of age for the baby. This is a relatively safe and successful treatment method. Recovery is also swift in most babies.

In case the doctor is not able to feel the baby’s testicle through a physical examination, then another type of surgical procedure may be performed using minimally invasive surgical procedure (laparoscopy).

Yet another treatment for this condition is hormone therapy. It results in the testicle to descend into the scrotum and prevents the need for surgical procedures. However, the success rates are quite low and this procedure also carries risks of side effects.


Why is it important to treat an undescended testicle?

It is important to correct an undescended testicle as it may increase the risk of:

  • Infertility – The damaged testicle’s ability of sperm production may be affected as early as at 12 months of age. Hence, doctors normally advise on correcting this condition by 1 year of age, or at least before the child turns 2 years old.

  • Testicular cancer – Men with undescended testicle are at higher risk of testicular cancer as compared to normal men. However, as this cancer is rare it can also be treated effectively if detected early on.


Why the procedure is performed?

This treatment is advised for babies older than 1 year who suffer from undescended testicle (also known as cryptorchidism).

There is significant difference between an undescended testicle and a ‘retractile’ testicle which causes the testicles to drop into the scrotum but retract back again. This condition does not require surgery.


Risks

Risks are normally associated with the anesthesia which is administered, such as:

  • Anesthetic allergy

  • Breathing issues

The risks associated with the surgical procedure may include:

  • Infection

  • Bleeding

The doctor/surgeon will take every possible precaution to prevent these types of complications from arising.


After the procedure

Most cases of undescended testicle are known to be successful. Only a small portion of these develop fertility problems.

People affected by undescended testicle are advised to perform regular self-examination throughout their lives to check for possible tumors as these are more prone to developing this type of cancer.


Outlook/Prognosis

The surgery is performed as an outpatient procedure. The doctor/surgeon usually advises bed rest of at least 2-3 days following the procedure. Strenuous physical activity (exercises) are to be avoided for at least a month after the surgery.


Alternate names

  • Orchidopexy

  • Inguinal Orchidopexy

  • Orchiopexy

  • Repair of undescended testicle

  • Cryptorchidism repair


What are the long term effects?

If treated early, there is a likely chance that the affected testicle will develop normally. in cases where the testicle is abnormal from the beginning, the growth of the testicle is affected.

In case the other testicle is normal then infertility is not normally seen. Long-term monitoring is required for undescended testicles. For such children, monthly physical examinations are advised. In case the testicle is absent or has been removed, then a testicular prosthesis made of silicone can be implanted. These are usually implanted at puberty due to the developing size of the testicles till this stage. This prosthesis also helps teenagers regain self-esteem and lead a normal life.

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