The testicles (eggs) begin to develop while the baby is in the mother's womb and move downwards both as it develops. At the end of the 7th month in the mother's womb, it passes through the abdomen into the inguinal canal, 7-8. It continues to progress in the inguinal canal in the last 6 months, and generally at the end of the 9th month, they complete their migration in the inguinal canal and descend into the scrotum (the bag in which the testicles are located). The descent of the testicles continues in the first 3 months after birth. If there is a pause in the descent of the testicles for any mechanical, hormonal or self-induced reason, the testis remains stuck at a point on the migration path and an undescended testis occurs.
Which babies are seen?
Since testicular migration is completed in 9 months, its incidence is naturally high in preterm babies. While this rate was reported as 30% in premature babies, it was reported as 2-3% in term babies. However, the fact that this rate was reported as 0.8% at the age of 1 after the infants were followed up suggested that the testis continued to migrate after birth.
Why doesn't it go down?
The structure called the gubenaculum, which is accepted as a guide during the migration of the testis, is not fully developed or if this structure is developed, but the scrotum (bag ) instead of being attached to another place, it is thought that it cannot reach the scrotum. Although there is no consensus on why the testicles do not descend, it is thought to be caused by hormonal reasons.
How to understand that the testicle does not descend?
When the eggs are not in the bag during manual examination, it is thought to be caused by hormonal reasons. understandable. For an ideal examination, the room should be warm, the child should be treated kindly, the feet should be crossed towards the abdomen (frog position), and the testicle should be tried to be found by stroking the inguinal canal. Sometimes it is also helpful to sit in hot water.
What kind of tests are done?
In general, manual inspection is sufficient. Sometimes the testis is not palpable, in this case, help can be obtained from ultrasonography. Magnetic Resonance Imaging (MR) can be applied if it cannot be detected on USG. Hormone studies can be done, but this only gives information about the presence of the testis, its location. and we cannot have an idea about its structure. In laparoscopic examination, an idea can be obtained about the presence, location, size and structure of the testis, and the process of lowering the testis into the scrotum can be performed in the same session.
If the testis is not in the bag (if it is not palpable), where is it?
If we consider that the testis started to develop in the area where the kidney was in the mother's womb and migrated downwards, the testis kidney It can be found in the lower part of the inguinal canal or just outside the inguinal canal. , there is no palpable testicle in these cases.
If the testicle is sometimes not in the sac and sometimes it is not in the sac, it is called shy (retractile) testis. It is brought into the bag during the examination and remains in the bag for a while. Similarly, if the testis, which can be brought into the bag with difficulty, does not remain in the bag and immediately goes up, this is called gliding.
If the testis is oriented to a different route during its normal migration, it is called ectopic testis. The testis can be towards the root of the penis, towards the outer edge of the bag, towards the leg, and in the perineum (close to the anus) outside the bag, but in its most common form, it has come out of the canal, however, it is located at the top of the bag and cannot be brought to the bottom of the bag in any way.
Infertility: It is more important in untreated patients, especially after 2 years of age. Because the changes in the testis begin after the 6th month, but important changes occur after the 1st year, these changes become irreversible after the 2nd year.
Malignancy (risk of cancer): The incidence of cancer in undescended testicles is 1%. The reason is that the facility has been exposed to high heat and pressure since the time it was in the mother's womb. It is 15 times higher in unilateral patients and 33 times more in bilateral cases. It is known that surgically removing the testis does not reduce the risk of cancer, but it still helps in the early diagnosis.
Inguinal Hernia: With undescended testicles. There is an inguinal hernia at the rate of 80%. Problems arise due to hernia.
Testicular Torsion: In undescended testicles, the rate of blood circulation deterioration by rotating around the testicles is higher than in normal testicles.
Risk of Trauma: In the inguinal canal, the testis is more open to physical trauma, easily crushed. Since it can move freely in the bag, it recovers from trauma more easily.
Psychological Effects: To avoid the psychological effects of testicular absence.
When should the undescended testis be operated on?
If an undescended testis is detected, the testicle should be surgically placed into the scrotum. The ideal age range for this job is 6-18 months. It is known that in cases with undescended testis after 2 years of age, the cells forming the testis are affected and lost.
What will we encounter after the operation?
It is generally performed as a day operation. Children are discharged 2-3 hours after the operation. However, there may be inflammation, bleeding, hematoma at the surgery site, albeit at a small rate. The testis, the nerves and vessels of the testis, the sperm-carrying duct can be damaged.
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