The testicles, which enable sperm production, are located in the abdomen while the baby is in the womb. The testicles begin to descend towards the sacs near birth, and when the baby is born, they descend into the bag called "scrotum". However, in approximately three out of 100 boys born on time, this downward progression cannot be completed and the testicles remain in the abdomen or in the groin. It is very dangerous for the testicles to remain elevated. The testicles, which are inside the body rather than in the bag, are exposed to 1 degree more heat than the testicles in the bag. This may cause sperm production to be negatively affected, meaning difficulty in conceiving. While the risk of not having a child is 15% in those with one undescended egg, this risk can go up to 70% in those with both testicles undescended. If the testicles do not descend into their sacs spontaneously in the first 6 months of life, they must be lowered with treatment. Medication or surgical intervention is required to lower the testicles. It is recommended that the testicles be lowered until 18 months at the latest to avoid problems in sperm production in the future.
Undescended testicle (Cryptorchidic testicle) is the failure of the testicle, which develops first in the abdominal cavity while a normal baby is growing in the womb, to descend into the bag. is known. Factors affecting the descent of the testicles from the abdominal cavity into the bag are the ligament called gubernaculum pulling the testicle down towards the bag, the intra-abdominal pressure pushing the testicle down, the genitofemoral nerve, which is a nerve that activates the muscles that will cause the testicle to descend, and some sex hormones. Unfortunately, an error in these results in undescended testicles.
The most common places where undescended testicles are seen are; It is the groin, intra-abdominal area and the area between the groin and the bag. Any testicle that is not palpable when the parents touch the bag should be considered an undescended testicle or should be taken to a pediatric urologist immediately. It is unnecessary to perform advanced tests such as ultrasound or tomography for testicles that cannot be detected by the physician in the groin or bag and cannot be found after a detailed physical examination, due to high error and low sensitivity. In these children, under anesthesia, a telescope must be placed in the abdomen and the testicle or sperm duct and vessels leading to the testicle must be searched. There is a procedure called laparoscopy that proves that a testicle has not developed congenitally. While the incidence of undescended testicles is 3.5% in normal-born babies, this frequency increases to 30% in premature babies. The incidence of bilateral undescended testicles covers 15% of all babies with undescended testicles. This rate increases in twin pregnancies, low birth weight, having a pouch in the waist (spina bifida), absence of abdominal muscles (prune belly disease) and premature birth.
Retractile or shy (retracting back during physical examination) ) testicles are usually found in children aged 5-10 years. In these children, the testicles have completed their normal descent. During the examination or if the child is cold or afraid, the testicles move towards the inguinal canal due to the increased cremasteric reflex, but later, when the environment warms up and the anxiety disappears, they descend back into the bag. These testicles are not considered undescended. Since cremasteric reflexes are weak in the first 5 years of life, retractile testicle is not diagnosed in the first five years of life. These testicles, which are sometimes in the groin and sometimes in the bag, are called sliding testicles or sliding testicles in the inguinal canal. The reason for this shift is that the abdominal membrane attached to the testicle has not yet separated from the testicle. The distinction between sliding testicle and shy testicle in all children should be made by pediatric urology specialists. Because shy testicles usually do not need treatment, floating testicles need to be corrected surgically.
Children whose both testicles are not in the scrotum require urgent attention during the newborn period. Because even though the child's penis looks like a boy, genetically the child may be a girl. Immediate differentiation of this is life-saving because some incorrectly secreted adrenal glands can cause the death of the baby within the first week.
It should not be forgotten that 74% of babies born at normal term and 95% of babies born prematurely are born prematurely. The testicles will descend spontaneously within the first 6 months of life. The main responsible for this decline is the male hormone secreted between 3 and 6 months. If the testicle does not descend spontaneously during this period, treatment must be planned.
Undescended testicles can cause two important problems. Difficulty in conceiving and risk of cancer. These problems may occur in testicles that are not in their normal position. Even in children like I who receive timely treatment, these risks may not disappear throughout life. Studies have shown that although the sperm-forming potential of the testicles lowered into the bag within the first 18 months turns into normal testicles, the tendency to cancer cannot be prevented. It is very important for the patient to make an early diagnosis of cancer in the testicle that is lowered into the bag during self-examination.
Patients who have had their testicles reduced to the scrotum through surgery should examine their testicles after puberty, and if they notice abnormal growth or hardness, they should immediately consult a urologist. The risk of cancer is 4-10 times higher than normal men.
The most commonly used method for undescended testicles is the surgical procedure called orchidopexy. The success rate of lowering the testicle safely into the bag with orchiopexy is 90-98%. This operation can be performed with a 2 cm incision on the groin or just above the bag, with an anesthesia of approximately 45 minutes. After the operation, the child rests for a few hours in the hospital and is sent home the same day. After 3 weeks, the location of the testicle is checked. While in the past, for testicles that were not palpable in the inguinal canal, a large incision was made on the abdomen and the testicle was searched to be lowered into the bag, today, with the technique called laparoscopy, a telescope is entered into the abdominal cavity and these testicles in the abdomen can be lowered into the bag without making an incision on the abdomen. After this procedure, the child can be sent home on the same day. This technique is successfully applied in some centers by pediatric urology specialists.
The ideal treatment time for undescended testicles is between 6 months and 18 months.
Hormones (human chorionic gonadotropin hormone (hCG) and luteinizing hormone releasing factor analogues) are used as drug therapy. However, since this hormone causes the child to secrete male hormones prematurely, it may cause hair growth, growth and color changes in the penis and bag. Treatment generally consists of administering 6 or 8 injections every other day, and unfortunately permanent success is around 15%. The most response is obtained in retracted testicles, called shy testicles, and this group improves without any treatment.
Even if children's genital areas appear normal in appearance, families should feel the presence of both testicles inside the scrotum by palpating. In case of doubt, they should consult a pediatric urologist.
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