The condition that one or both testicles do not descend into the sac (scrotum) in boys after birth is called undescended testis (cryptorchidism). Undescended testis is one of the most common congenital defects in boys.
Incidence of incidence
It can be seen in 1% – 4.6% of term baby boys and 1.1 – 45% of premature babies born prematurely. . In the first few months after birth, the process of descent of the testicles into the sac may continue, and undescended testicles are seen in approximately 1% of boys who reach the age of 1 year.
70% of undescended testicles are unilateral and 30% are bilateral. . The vast majority of unilateral ones are right-sided.
Why does an undescended plant develop?
hormonal, genetic, and environmental factors in the development of the undescended testis factors are thought to be influential. The testicles begin to develop under the influence of some hormones, starting from about 7-8 weeks in the womb, and towards the end of pregnancy, they descend into the scrotum by passing through the inguinal shadow with the help of hormonal and genetic factors. The reason why the testicles are outside the abdominal cavity is that the temperature required for their development is lower than the body temperature.
The following reasons are thought to cause the development of undescended testicles:
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Premature birth
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Low-weight birth
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Other urinary system diseases
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During pregnancy hormonal disorders
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Alcohol, smoking during pregnancy, exposure to some toxic substances
How is the diagnosis made?
It is noticed during the family's observations at home or during the general child examination and is finalized in the examination of the Pediatric Surgeon. During the examination, the testicles may be palpable or not found anywhere other than the sac.
If necessary, ultrasonography is performed. MR or computed tomography is used much less frequently
Intra-abdominal examination in non-palpable testicles with a closed method (laparoscopy) for both diagnosis and treatment� dr.
Types of undescended testicles
There are two main types of undescended testicles: palpable and non-palpable
Paleable undescended testis:
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Inguinal (in the groin area)
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Ectopic (outside the normal descent path) somewhere: at the edge of the thigh, near the root of the penis, in the contralateral sac)
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Retractile testis (shy testis)
Intangible testis:
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Inguinal
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Ectopic
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Inside the abdomen
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Missing testicles
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Previously underdeveloped
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Testicles that subsequently stopped developing and regressed
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The most common form is the undescended testis, which is palpable in the inguinal region. Other types are rarer and require detailed examination.
What is a retractile testis?
Retractile or shy testicle is caused by the muscles hanging the testis for various reasons. (cold, fear, trauma) is the condition of the testis to go up from the sac after contraction. It usually resolves spontaneously up to 6-7 years of age. However, if the testis mostly spends time outside the sac and in the groin area during follow-ups, it should be considered as an undescended testis and should be surgically lowered.
In some cases, the testis in the sac at a young age is replaced by the growth of the child and an undescended testis may develop. This is seen in cases where the growth rate of the ligaments hanging the testis cannot keep up with the growth rate of the child and requires surgery.
Acquired undescended testis
The testicle that was previously in place may go up after surgical operations on the inguinal region, and this is called an acquired undescended testicle.
When and how should it be treated?
Children with undescended testicles at birth are followed up to 6 months. After this age, undescended testicles have a much lower chance of descending and need to be treated. Treatment
up to the child's 1 year of age, at the latest It should be done by 18 months.
The descent of the testicles into the sac in premature babies may continue for a longer period of time after birth, and therefore, it should be followed until the corrected age of the children is 6 months. is lowered into the pouch. The success rate is between 89-100% in unilateral cases, and it is lower in bilateral cases. In the testicles inside the abdomen, the chance of success is slightly lower and may require several-stage laparoscopic surgery.
Pre-operative, time of surgery and postoperative period
Pediatric surgery and anesthesiology specialists before surgery for undescended testis is examined in detail. Necessary analyzes are taken.
The surgery is usually performed through a small incision made in the groin under general anesthesia. The testis is found and lowered into the sac. If there is a simultaneous inguinal hernia, it is repaired with the same surgery. The skin is then closed with absorbable cosmetic stitches. There is no need for stitches afterward. Simultaneous circumcision can also be performed according to the family's request. This situation does not cause additional distress or extra pain for the child after the operation.
Since the testicles are not palpable in the preoperative examination, the abdomen is examined laparoscopically with a closed surgery. A few situations may be encountered during the laparoscopic view.
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If it is seen that the cord and vessels leading to the testis enter through the inguinal canal, the laparoscopy is terminated and the operation is continued from the inguinal region.
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If the undescended testicle is seen just at the entrance of the inguinal canal or anywhere in the abdomen (on the abdominal wall or close to the kidneys), the testicle is lowered into the pouch from the inguinal region in one or two stages with the closed method.
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The testis remaining in the abdomen may be much smaller (atrophic) than it should be
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In some cases, the cord and vessels leading to the testis end blindly and the testicle may not develop.
Whether in the groin or If it is seen that the testis in the abdomen is smaller than normal and undeveloped (atrophic), the testicle is removed by informing the family. In cases of undescended testicles (especially intra-abdominal) in children past puberty, removal of the testis is recommended despite the risk of malignancy.
The child is fed and discharged home within a few hours after the surgery. Afterwards, they are called for control at certain intervals.
What should be considered after the surgery?
Regular follow-up controls in the post-operative period are important . In the early postoperative period, infection or bleeding may rarely occur at the wound site, and temporary swelling and bruising may occur in the sacs. In the late period, although rare, the testis may go up from where it was lowered, and there may be a reduction in the size of the testis.
What happens if the undescended testis is not treated?
If the testicles are not lowered in time, it can lead to some undesirable situations. The main ones can be listed as follows:
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Infertility: Although the risk is low in unilateral cryptorchidism, the risk is higher in bilateral diseases. Those with unilateral undescended testicles will have the same future fertility rate as people in the community due to normal functioning of the opposing testis. However, those with bilateral undescended testicles have a slightly lower chance of having children in the future. In those who have a later surgery, this chance is slightly less because the testis is more affected
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Testicular tumors: The risk of developing testicular cancer is 5-10 times higher in men with a history of undescended testicles than in those who do not. While this risk increases in bilateral undescended testis, this risk is higher in those located in the abdomen. In addition, delaying the age of surgery may also increase the risk of cancer.
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Trauma: The testicles located in the groin area are more vulnerable to trauma due to their location.
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Testicular torsion: Although rare, the rotation of the undescended testicles causes vascular occlusion and requires urgent intervention, in some cases it can lead to organ loss
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Inguinal hernia: Majority Inguinal hernia may accompany most of the undescended testicles, although the majority of them are not clinically symptomatic. These hernias are also repaired at the time of undescended testicle surgery.
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Psychological Effect: Undescended testis in young children may cause psychological problems in the child's parents, and in later periods in the child himself due to the appearance.
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