What is Undescended Testis?
The failure of the testicle (or "testicles") to descend into the scrotum (skin sac under the penis) is called undescended testicle "cryptorchidism, hidden or undescended testicles". Although this condition is rare, it is usually seen in premature babies. As the male fetus grows in the womb, the testicles appear and show themselves in the abdominal area, near the kidneys. In the seventh month of pregnancy, the testicles begin to descend from this area towards the groin. They should reach their final position in the scrotum 6 months after birth. The main function of the testicles is to produce the male hormone testosterone and sperm. An undescended testicle can produce hormones, but its ability to produce sperm is greatly impaired. Approximately 1% of 1-year-old male babies are diagnosed with undescended testicles. It is the most common congenital anomaly of the genital organs in newborn male babies. Usually, only one testicle is affected, but the probability of both testicles not descending is approximately 10%.
Causes of Undescended Testicles: It is not known why some testicles do not descend.
Risk factors are as follows:
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Having family members with undescended testicles or other genital organ anomalies
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Premature birth or low birth weight
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Conditions that affect baby growth in the womb
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Mother's use of alcohol or cigarettes during pregnancy
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Long-term exposure or exposure to some agricultural pesticides remaining
Undescended Testicular Types
Undescended testicles are testicles that may or may not be palpable during examination. It is divided into two groups. A palpable undescended testicle may be located in any area on the normal descent path. Sometimes the testicle may be located somewhere outside the normal descent path (outside the scrotum), this is called ectopic testicle. In some patients, a strong cremaster muscle reflex may cause the testicles to move back and forth between the scrotum and the abdomen, this type of testicle is called retractile testicle. A non-palpable undescended testicle is usually located in an area in the abdomen. Genital organs� It can be located above the inguinal ring-ligament, around the kidney, between the rectum and bladder, or near the stomach wall. Treatment is decided according to the location of the testicles and the presence of testicles. Ectopic palpable testicles require surgery. Retractile testicles that are manually lowered can be waited until puberty under close monitoring. If both testicles cannot be felt by hand and sexual differentiation is appropriate and present; An endocrinological and genetic evaluation should be performed. Patients and their relatives usually consult a doctor with the complaint of not being able to feel the testicles in the scrotum (bags). The testicle is typically not noticed when a baby is examined immediately after birth. Undescended testicles need to be monitored with regular check-ups during the first 6 months. If the testicle does not descend on its own, it will need treatment.
Diagnosis
Physical Examination: With physical examination, undescended testicles can be felt by hand. and is classified as non-palpable (palpable/non-palpable). Imaging methods are not very helpful in this regard. For the examination, the child is laid on his back with his legs in the frog position. If one testicle is non-palpable, undescended, and the other is larger than normal, one testicle may be underdeveloped or atrophic (small). The abdomen should be visually examined to ensure that the undescended testicle is not ectopic.
Diagnostic laparoscopy: Laparoscopic intra-abdominal examination (camera examination) is the only way to reliably diagnose a non-palpable testicle. . Laparoscopic evaluation is recommended to be examined under general anesthesia, some testicles that were not palpable before the procedure may become palpable, general anesthesia provides us with this opportunity
TREATMENT
Testis If it does not go away on its own, treatment will be needed. The aim of the treatment is to prevent problems that may occur in sperm and hormone structure and to reduce the risk of developing testicular cancer, which is 7-14 times more common in normal people. Surgery should be performed around the age of 1 or within the first 18 months at the latest.
Hormonal therapy: In some cases, hormone therapy may be applied to allow the testicle to descend into the scrotum on its own.
Surgery
Orchiopexy: Basement of undescended testicle The treatment is to move the testicle to the scrotum (orchidopexy) by surgical method. If a testicle has not fully descended into the scrotum in the first 6 months, surgery must be performed within the next 1 year. Delayed treatment may increase the risk of testicular cancer and/or infertility in the future. Surgery for a palpable testicle is performed with two incisions: one in the area where the testicle is located and the other in the area where the testicle will be placed in the scrotum. For non-palpable testicles, laparoscopic examination may be required, it is the best way to determine the location of the testicle, general anesthesia is required for this. If necessary, complete removal of the testicle or its normal positioning can be done with laparoscopy.
Follow-up:
Those who had an undescended testicle in childhood can have children, those whose undescended testicle surgery was performed before 18 months have the same chance of becoming a father as with a normal man. is almost the same. The risk of developing testicular cancer in children with undescended testicles is very high (7-14 times) compared to other men. Therefore, periodic and regular check-ups are necessary during and after adolescence in those with a history of undescended testicles. Cases with retractile (descending) testicles do not need medical or surgical treatment, but they should be closely monitored until adolescence.
Recommendations for undescended testicles:
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There is no need for medical or surgical treatment for retractile testicles, but close follow-up is required until adolescence.
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The process of lowering the undescended testicles into the scrotum occurs at the age of 1 year or within 18 months at the latest.
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In patients with non-palpable testicles and if sexual development disorder is not obvious, laparoscopic examination is the best way to find the testicle. The testicle can be removed or repositioned in the same session.
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Hormonal treatment is not a standard treatment.
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In children aged 10 years or older, if one testicle is normal and the other testicle is in the abdomen and cannot be palpated, removal of the testicle may be considered due to the risk of developing testicular cancer later.
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Newborn babies whose testicles cannot be palpated should be evaluated for possible disorders of sexual development.
Frequently Asked Questions:
1- The pediatrician did not feel my son's testicles where they should be after birth. What should we do?
Your pediatrician will need to check your child's genital organs regularly. The testicles may descend naturally for up to 6 months. If they do not descend on their own, he will recommend a treatment and send him to a pediatric urologist.
2-At what age do the testicles descend?
The testicles must be completely descended by the age of 6 months. .
3- The doctor said that I should watch the position of the testicles, but I cannot find them in the bags. What should I do?
Watch your child during a hot bath or when he is relaxed after sleeping. Try to examine it. If you still cannot feel the testicles, let your doctor know.
4- Can we avoid surgery if our child has an undescended testicle diagnosed by the doctor?
Speak your concerns to the pediatrician or pediatric urologist. bring it. Your doctor will help you decide whether surgery is needed. The pediatric urologist will tell you what the right treatment is and, if necessary, recommend the type and type of operation.
5- Our child is 12 years old, at his last examination, the pediatrician said that he felt the testicle in his abdomen, but it also descends into the scrotum from time to time. The testicle is damaged. Is it?
Usually, conditions inside the abdomen are not good for the testicles and they can lose their function. The testicle can naturally move back and forth between the scrotum and the abdomen (retractile) and no surgery is needed. Your knowledge about the position of your son's testicles in a relaxed state may play an important role in deciding on further treatment (operation).
6- Our son had surgery to lower his testicles into the scrotum (instead of normal). The effect of surgery on infertility. is there? Can she have children when she grows up?
The rate of boys who had orchiopexy before the age of 18 months is almost the same as that of other children. Men with bilateral undescended testicles are at greater risk of infertility, so sperm testing may be done after puberty to check fertility potential
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