What are Undescended Testicles? Causes, diagnosis, treatment

What are Undescended Testicles? Causes, diagnosis, treatment
Medicine

What are Undescended Testicles?

An undescended testicle (or “testis”) is when it fails to drop into the normal place in the scrotum. Your child’s health care provider can find this during a routine exam. This issue is found in about 3 or 4 out of  100 newborns (and up to 21 out of 100 premature newborns). Luckily, about half of these testicles will drop on their own during the first 3 months of life. But testicles won’t drop on their own after 3 months of age. Thus, about 1 or 2 out of 100 boys with undescended testicles will need treatment.

It’s important not to confuse undescended testicles with “retractile” testicles. After 6 months of age, a male child has a reflex that temporarily pulls the testicles up to protect them when he’s cold or frightened. These testicles are in the scrotum at other times and don’t need treatment. Only testicles that are truly undescended need treatment. A pediatric urologist can tell the difference with a physical exam.

The testicles need to be 2 to 3 degrees cooler than normal body temperature to make sperm. The scrotum is many degrees cooler than body temperature, and so is the ideal place for the testicle. Testicles that don’t drop into the scrotum won’t work normally. The longer the testicles are too warm, the lower chances are that the sperm in that testicle will mature normally. This can be a cause of infertility, especially when both testicles are affected.

Undescended testicles are also linked to a higher risk of:

  • Testicular cancer in adulthood (though the risk is still less than 1 in 100)
  • Testicular torsion (twisting of the chord that brings blood to the scrotum)
  • Developing a hernia near the groin

What Causes Undescended Testicles?

In most children with this health issue, it’s not known why the testicles fail to drop. It may be because the testicles aren’t normal to start with. In other cases, there’s a mechanical problem. The testicles drop but miss the scrotum, ending up next to the scrotum instead. These are called “ectopic testicles.” Or it may be that the baby’s hormones can’t stimulate the testicles normally. No studies have shown that the problem is caused by something the mother did or ate during pregnancy.

Sometimes the testicles drop but don’t attach in the scrotum. Then, when the boy grows, it becomes clear that the testicles aren’t attached. About 1 of every 5 cases of undescended testicles are found once the boy is no longer a baby. For this reason, all boys should have the location of their testicles checked during each annual physical exam.

How are Undescended Testicles Diagnosed?

A testicle that can’t be felt in a physical exam is called “nonpalpable.” Nonpalpable testicles may be in the abdomen (undescended), absent, or very small (“atrophic”). It’s important to find out whether there is a testicle that hasn’t dropped. An undescended testicle left inside the abdomen could form a tumor later in life. Such a tumor might not be noticed until it becomes quite large or causes symptoms. Unfortunately, there’s no test, such as an ultrasound, that can definitively show whether a testicle is there. Surgery is the only way to find out for sure.

Pediatric urologists are experts in both open and laparoscopic surgery. Laparoscopy is surgery done through thin tubes put into your child’s body through a small cut. The surgeon uses a special camera to see inside your child’s body. The surgeon will find one of 3 situations:

  1. Blind-ending testicular blood vessels – proving there’s no testicle
  2. Vessels leaving the abdomen – proving there’s no testicle in the abdomen
  3. A testicle in the abdomen. If a testicle is found, it’s brought down into the scrotum or removed, based on its condition.

How are Undescended Testicles Treated?

The testicle won’t drop after 3 months of age, so the only treatment choice is surgery. Surgery is recommended after 6 months of age. The timing takes into account when the child is able to handle anesthesia and the surgery. Drugs or hormone treatment aren’t useful.

This surgery is called an orchiopexy. The child is put under (general anesthesia) for this surgery. Almost always the child can go home the same day and is back to normal within 1 to 2 days. A cut about 1 inch long is made in the groin area (most often it can hardly be seen later). The testicles is freed from all nearby tissues so that it moves easily into the scrotum. Then it is stitched into place. If there’s a hernia, it’s fixed at the same time. In some cases, the testicle is too high for this simple surgery. If this is the case, more complex methods (and sometimes even 2 surgeries) are needed. Overall, the success rate with surgery is 98 out of 100.

Facebook Comments
84-year-old doctor refuses to use a computer - Lost her medical license
Blog
84-year-old doctor refuses to use a computer – Lost her medical license

According to Washington Post, Aside from a fax machine and landline telephone, there isn’t much technology in the office of physician Anna Konopka, 84. Instead, her patients’ records are tucked into two file cabinets, which sit in a tiny office next door to her 160-year-old clapboard house in New London, …

Operating theatre related syncope in medical students: a cross sectional study
Blog
Operating theatre related syncope in medical students: a cross sectional study

Abstract Background Observing surgical procedures is a beneficial educational experience for medical students during their surgical placements. Anecdotal evidence suggests that operating theatre related syncope may have detrimental effects on students’ views of this. Our study examines the frequency and causes of such syncope, together with effects on career intentions, …

“Everyday is a Battle” — Teenager’s Life Is Forever Ruined by the Dangerously Ineffective HPV Vaccine. Here’s Her Incredible Story!
Blog
“Everyday is a Battle” — Teenager’s Life Is Forever Ruined by the Dangerously Ineffective HPV Vaccine. Here’s Her Incredible Story!

The HPV vaccine is recommended for all girls between 11 and 12, but reports like this one have meant the vaccine has been branded as one of the most dangerous in the world. Chloe was a seemingly normal pre-teen, she loved to dance and one day hoped of becoming a …