The most common testicular pathologies in boys are undescended testis (the testicle is not in the bag), hydrocele (Water Hernia) and varicocele.
UNDESCENDED TESTES
It is one of the most frequently encountered diseases in pediatric urology. It is seen in 3% of a term baby and 1% around 1 year of age. It can be seen bilaterally in 10-25% of cases. Born before 37 weeks and <2500 g. Babies born with undescended testicles are at risk for undescended testicles.
Acquired undescended testis cases are encountered in children who were previously normal at the age of 2 and 8-10 years. While 80% of the undescended testicles are palpable, 20% are not. While 20% of these testes that cannot be felt are palpable under anesthesia, the rest are normal or smaller than they should be in the abdomen.
What Happens If the Testicle Is Not Descended in the Bag?
Testicle When it does not descend, the number of Leydig Cells responsible for Testosterone secretion and the dimensions of the seminiferous tubule, which has an important place in sperm formation, decrease. Since these testicles are exposed to 2-4 degrees extra temperature, 2% of the germ cells responsible for sperm formation are damaged for each month the testicles are above, while 1% of Leydig cells responsible for Testosterone production are lost.
Testosterone production in unilateral undescended testes. continues and these children enter puberty, the other testicle takes over the task of the affected one in terms of fertility. Delayed treatment in bilateral undescended testes is a serious cause of infertility. The earlier the treatment, the better the sperm parameters and testis growth. shy testis). Overactivity of the Kremester muscles is held responsible. 10-50% of these testicles are misdiagnosed as undescended testicles. Annual follow-up is recommended for retractile testicles. Approximately 30% of these may become undescended testicles within three years and require surgery.
What Happens If Undescended Testicle Is Not Operated
Children with undescended testicles may experience the following reasons: due to a must be surgery;
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Infertility
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Testicular Cancer
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Hernia
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Testicular Torsion
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Cosmetic-Psychological cause
HYDROCELE
It is a painless collection of fluid in the scrotum (the bag in which the testicles are located). When the baby is in the womb, the testicles are in the baby's abdominal cavity during their formation. It completes its descent into the scrotum near birth, closing its connection with the intra-abdominal cavity. In hydrocele, although the testicles descend into the scrotum, this connection is not closed. From time to time, fluid enters the scrotum through the abdomen and there is an increase in scrotum size, especially later in the day. If the connection is small, it is accompanied by fluid collection only in the scrotum, if the connection is wide, the small intestines can pass through here and cause a hernia.
The diagnosis is made by physical examination and, if necessary, by ultrasound guidance.
Treatment What is it
It usually disappears on its own within the first year. For this reason, babies born with hydrocele are not operated immediately and are followed up. If the scrotal swelling does not decrease and disappear afterward, surgical treatment is planned. This is usually done after 12-18 months.
Is the surgery difficult?
It is a daily surgery performed with a 2 cm incision from the inguinal region under general anesthesia.
VARICOCELE
Varicocele is defined as the enlargement of the veins coming from the testis. It is detected at a rate of about 15% in adolescence and may cause progressive damage to the testis. Among the causes of male infertility, it is one of the causes that can be corrected by surgery.
20-30% of men who apply for infertility in later ages have varicocele. >Temperature increase in testis, insufficient oxygen, reflux of harmful substances in kidney and adrenal gland to testis, shrinkage of testis and infertility due to ROS and Oxidative Stress.
How to Diagnose
Diagnosis is made by physical examination before and during puberty.
2nd Degree: Veins that are palpable without straining on the foot but cannot be noticed from the outside. The risk factor can be defined according to the difference in both testicles.
The difference in size and consistency between the patient's testicle on the side with varicocele and on the other side is important. If there is a difference in consistency between the 2 testes on physical examination and there is a difference in size between the two testes in the measurements, it indicates that the patient is at risk for infertility.
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