Undescended Testicle

In men, the testes complete their development in the first two months of pregnancy and are located in the abdomen, where they secrete hormones for sexual differentiation. In the 7th month of pregnancy, under the influence of testosterone, the testicles in the abdominal cavity begin to descend into the scrotum (the bag surrounding the testicle). As birth approaches, the testicles move towards the scrotum, cross the inguinal canal and settle in the scrotum. If this descent is incomplete and the testicle remains in the inguinal canal or abdominal cavity, it is called an undescended testicle. Most of the time it is unilateral, sometimes bilateral.

In this surgery, which takes place in one day and in one session, the patient is prepared as in inguinal hernia. The testicles are then removed from the body and placed in the lower part of the scrotum. If one of the testicles melts during this procedure, it will be removed with the permission of the family. The patient should visit the doctor at intervals determined by the doctor.

There are some conditions that may occur in the patient after surgery. These situations can occur quite frequently. Wound infection, back leakage, late sperm duct obstruction and infertility problems are among the problems that can be seen after surgery.

An undescended testicle can be corrected with an easy surgery. Undescended testicular disease, which is detected in a shorter time with the developing medical technology, is detected in newborn babies until they are 6 months old and this treatment should never wait until the child is one year old. In a 6-month-old baby boy, if the testicles have not descended into the scrotum, surgical intervention is absolutely necessary.

What is an Undescended Testicle?

An undescended testicle is a health problem that only occurs in boys. This condition can be congenital, but can also be caused by hormones or groin surgery. This condition can cause major problems for a man and needs to be treated.

How is it Diagnosed?

On examination, the testicle is felt to be in the inguinal canal, not in the scrotum. Sometimes the testicle may not be palpated in this canal either. Ultrasound or laparoscopy is used to locate the testicle in the abdomen. In this case, the testicle can sometimes be lowered into the scrotum or, if the testicle is decomposed, then the remains of the decomposed testicle are found and removed.

As a result, we can also differentiate undescended testicle as palpable (felt on examination) or non-palpable. For the palpated undescended testicle, the testicle is brought into the scrotum by surgery (inguinal orchiopexy) at the appropriate time. For a testicle that cannot be palpated (located in the abdomen), laparoscopy or open surgery (exploration) should be performed and the testicle should be lowered into the scrotum (if the testicle is alive) or removed (if the testicle is decomposed) depending on its condition.

What is Retractile Testis (shy testicle, testicle that can go up and down)? Should it be operated?

In this condition, also known as “shy testicle” or “cowardly testicle”, the testicle or testicles occasionally protrude from the scrotum into the inguinal canal. The testicle usually escapes upwards towards the groin due to the cold or when the child touches it; in the heat and when the child is asleep, it is seen in the scrotum. Retractile testicles have completed their descent, unlike true undescended testicles, which is an innocent condition in which the testicle sometimes protrudes into the inguinal canal as a result of strong reflex contractions. Children with retractile testes do not need any surgical or medical treatment. Follow-up at 6-month intervals is necessary until puberty.

Symptoms of Undescended Testicle

The signs of an undescended testicle are easy to recognize, but should always be checked by a specialist. In order to have an undescended testicle, the testicles should not be in a place called the scrotum. If a newborn child has this condition, you should consult a doctor immediately.

The doctor’s hands should not be cold during the testicular examination. Because; if there is cold contact when touching the testicles of the child, the child will not want to and will be afraid. In addition, attention needs to be paid to the environmental conditions and the interaction between the doctor and the child. One of the most important things to know is that if there is a water hernia in the testicles, the scrotum may be thought to be full for this reason. This is also taken into account during an examination by a specialist doctor.

Effects of Undescended Testicle

Children who are born prematurely may have some health problems because their bodies are not fully developed in the womb. One of these is the problem of an empty scrotum, i.e. an undescended testicle, which occurs in the premature birth of boys. This problem has different effects on children. You can see what the effects are in the list below:

– One of the biggest problems is that the hormone testosterone and sperm cannot be produced in the body. As a result, the boy may not develop male characteristics in later years and infertility may occur.

– It can increase the risk of testicular cancer, which occurs in every man, by 4 to 10 times.

– Because the testicle is not inside the scrotum, it can rotate around its veins and prevent blood from flowing to it. Over time, this can even cause the testicle to lose its function.

– An undescended testicle can cause trauma.

– Inguinal hernia formation may occur.

– Because the scrotum is empty, the person may feel incomplete or face other psychological problems.

– Although there is no definitive information, some experts think that if the number of testicles that do not descend into the scrotum is one, it will cause various damages to the other testicle. This idea is not conclusive as it is rejected by some experts.

– A man’s testicles are always 2 to 4 degrees lower than body temperature. This temperature is very important for the testicle to function and develop well. Since the undescended testicles are located inside the body and not in the scrotum, they are in a warmer environment compared to this temperature. This can lead to various problems.

– An undescended testicle that remains inside the body can be severely damaged by high temperatures if left untreated for 6 months. One of these harms is infertility. Infertility, which is highly likely to occur but not always, means that a person will not be able to have children in the future.

– As a result of the surgery performed by specialist doctors, the testicles are lowered into the scrotum and the testicles continue their development from where they left off. In testicles that are recognized early and lowered into the scrotum in a short time, the problem of infertility is very low. On the other hand, testicles that remain inside the body for a long time have a high rate of infertility even if they are lowered back into the scrotum.

– One of the biggest problems caused by undescended testicles is malignant tumors. People who develop these tumors are usually in their late 30s, but there is no certainty that the risk of undescended testicles is reduced. Therefore, it is necessary to pay attention to this situation, knowing that it can happen even at a young age.

Undescended Testicle and Infertility

Normally, the temperature of the scrotum (the bag surrounding the testicles) is about 2°C lower than the temperature inside the body. Damage to the testicle in the groin or in the abdomen (i.e. constantly exposed to high temperatures) begins to occur. If both testicles are undescended, infertility is almost inevitable in the following years. (It has been experimentally demonstrated by electron microscopy that damage to the tissues within the testicle, namely the seminiferous tubules, occurs in the testicle that is constantly exposed to high temperatures).

In addition, undescended testicles may develop structural damage, loss of function and atrophy (decay) in the testicle in the following years. If this abnormal testicle is left in the body, tumors can develop from this structure. (Malignant transformation) Patients with undescended testicles are 20-25 times more likely to develop testicular cancer in the future than normal men.

When Should Undescended Testicle Treatment Be Performed?

The only treatment for undescended testicle is surgery. In an operation called inguinal orchiopexy, the testicle is lowered into the scrotum through a 2 cm incision in the groin area. The operation takes about half an hour and is performed under general anesthesia. The patient is discharged on the same day after surgery. Undescended testicle treatment performed by a qualified specialist has a very high chance of success (success rate is around 95%).

If the testicle is in the abdomen, as I mentioned above, the testicle is found by laparoscopic or open surgery; if the testicle is alive, it is lowered, if it is atrophied, it is removed. The right time for surgery is 1 year of age. Until 1 year of age, it should be followed up intermittently. Hormone therapy may be tried in some cases during this period. However, the testicle that is observed until the age of 1 year but has not descended into the scrotum should be surgically lowered.

As a result, in undescended testis, which is a problem that can be completely corrected surgically, it is important for the family to be very conscious and to consult an experienced specialist until the age of 1. Since it will be almost impossible for the testicles to descend on their own after the age of 1 year and the structure of the undescended testicle will start to deteriorate after the 12th month, it should be treated surgically.