What is an Undescended Testicle? Symptoms and Treatment

The testicles are the male reproductive organ responsible for the production of sperm and the secretion of sex hormones. The condition in which the testicles cannot reach where they should be during the development process in the mother's womb is called undescended testis (cryptorchidism). The testicles are located in the abdomen during the embryonic period in the mother's womb. During embryonic development, the testicles descend into the scrotum. The scrotum is the bag-like structure that contains the testicles. Undescended testis is when one or both of the testicles do not descend into the scrotum and remain in the abdomen or groin.

What are the Symptoms of an Undescended Testicle?

The most important symptom of an undescended testis is the less developed, small size of the scrotum on the problematic side. is the appearance. In rare cases, the undescended testicle may become entangled (testicular torsion), causing severe groin pain. In this case, the nearest health center should be applied immediately.

How to Identify an Undescended Testicle?

Undescended testis is diagnosed by noticing the absence of testis in the scrotum of the patient or by detecting that the testis is not in place during manual examination. In the neonatal period, undescended testicle examination should be performed during the genital system examination. The undescended testis may be unilateral or there may be a situation where both testicles remain in the abdomen.

Why Undescended Testicle Occurs?

The formation mechanism of the undescended testis has not been fully clarified yet. It is thought that many factors such as genetics, maternal health and environmental factors play a role in the development of this process. With the combination of one or more of these factors; Some physical and hormonal changes occur that prevent the testis from descending normally.

Some factors increase the likelihood of undescended testicles in babies. These are:

• Low birth weight
• Premature birth
• Familial presence of an undescended testis or other genital organ anomaly
• Feet in the womb conditions that limit the development of the disease (such as Down syndrome)
• Mother's use of alcohol during pregnancy
• Mother's smoking or passive smoking
• Parents' exposure to certain chemicals. The incidence of undescended testis is increased in babies affected by these factors.

Retractile testis, testis It is a condition that occurs as a result of overactivity of the muscle holding it in the scrotum. In the retractile testis, the testis is located where it should be. However, in some cases, as a result of excessive activity of the muscle, it is withdrawn and goes into the abdomen. It comes back when muscle activity ends. In this case, no treatment is needed. In those with a retractile testis, this condition may progress to an undescended testis over the years. If it progresses to the undescended testis, the need for treatment arises.

What Causes the Undescended Testicle?

In order for the testicles to develop and perform their functions, they must be at temperatures slightly lower than body temperature. When they are at body temperature, they have problems performing these functions. Therefore, having the testicles in the scrotum protects them from body temperature. The temperature in the scrotum is 1-2 degrees lower than in the body.

The undescended testicle is located in the abdomen or groin, not in the scrotum. So it is at body temperature. High temperature causes problems by disrupting their functions.

Infertility is one of the negative effects of undescended testis. Sperm count and quality decrease. While the condition in which one testis is affected does not pose a very high risk for infertility, the risk of infertility increases significantly when both testicles are affected. If undescended testis treatment is delayed for a long time, the situation may worsen in terms of infertility. Therefore, men diagnosed with undescended testicles should be treated as soon as possible.

Testicular cancer; It is more common in people with undescended testicles. cancer risk; It is more when the testis is in the abdomen than when it is in the groin. Again, the risk is higher in people whose both testicles have not descended. Surgically lowering the undescended testis can reduce the risk of cancer, but it does not completely eliminate it.

Testicular torsion is the entanglement of the spermatic cord. spermatic cord; It is a structure that contains blood vessels, nerves, and the tube that allows the passage of sperm from the testis to the penis. Torsion of this structure causes the flow to the testis to stop. It is quite a painful condition. If immediate intervention is not performed after the blood flow stops, the testicle may be lost. Torsion is 10 times more common in people with undescended testicles than in the general population. r may become vulnerable to trauma. It may be injured as a result of an external effect.

Inguinal hernia is another condition that can be seen in people with undescended testicles.

How to Diagnose Undescended Testicle?

• When it is noticed that there is no testis in the scrotum after birth, either unilaterally or bilaterally, the doctor performs an undescended testicle examination.
• The path of the testicles from the abdomen to the scrotum is palpated (by palpation) and the location of the testis is tried to be determined. In most cases this will suffice. However, in cases where the location of the testis cannot be determined by palpation, the laparoscopic method is preferred.
• In the laparoscopic method, a small incision is made on the abdomen of the patient and a thin tube with a camera at the end is advanced into the abdomen. With the help of the camera, the location of the undescended testis is tried to be determined. The advantage of the laparoscopic method is that the doctor can lower the testis that he or she has determined during this procedure. In other words, the laparoscopic method can be used both as a diagnosis and a treatment method. However, in some cases, this method is not sufficient to lower the testis and additional procedures may be needed.
• Open surgery in which a large incision is made on the abdomen and the abdomen is opened to look for the undescended testis may also be necessary in some cases.
• Imaging methods such as X-ray and ultrasound can also be used by the doctor for diagnosis.

Another condition where the testis cannot be felt in the scrotum is testicular agenesis. In this case, the testis may have never formed in the womb, or it may have stopped at a very early stage of its development. In testicular agenesis, there is no testicle and serious consequences may occur as a result. Absence of testis should be considered in cases where the testicles are not felt during the examination and the testicular structure cannot be seen with various methods such as the laparoscopic method. MRI with contrast material can be used to show the absence of testis.

What are the Treatment Methods for Undescended Testicle?

In babies with undescended testicles, testicles can descend into the scrotum spontaneously up to 3-6 months. If there is still an undescended testicle in babies older than 6 months, it should be treated. When the undescended testis is left untreated for a long time, the risk for many undesirable effects increases. Therefore, it is recommended to perform undescended testis surgery before 18 months. It is healed.

In the surgical method; The testis is carefully lowered into the scrotum and fixed in place. This method is also called orchiopexy. It can be done by laparoscopic or open surgery. The success rate of orchiopexy in the treatment of single undescended testis is close to 100%.

In some cases, the testis may be underdeveloped, abnormal or dead tissue. In such cases, the surgeon removes the distorted testicular tissue.

Undescended testis may be associated with inguinal hernia. Those who have undescended testis surgery can also be treated for hernia repair during surgery. In the follow-up, examination of the testicle with ultrasound and measurement of hormone levels are used. HCG (human chorionic gonadotropin) hormone given by injection can cause the testicles to descend into place. Hormone therapy has a lower chance of success than surgery. Therefore, the first choice in the treatment of undescended testicles is surgery.

_{Read: 0}