What is Undescended Testicle?

In boys, the testicles that should be in the scrotum are in an area where they can be damaged (in the groin, in the abdomen, etc.). The right, left, or both testicles may not have descended. In other words, when we look and examine, the scrotum (scrotum) is empty.

 

Figure; Left undescended testicle, left scrotum empty

What is the Frequency of Undescended Testicles?

Undescended testicles at birth are seen in 3-3.7% of term babies and 33-60% of premature babies. The frequency of undescended testicles increases as birth weight decreases. Testicles can descend into the scrotum within the first year after birth, and therefore the rate of undescended testicles at one year of age is approximately 1% on average. Testicles most commonly descend into the scrotum within the first three months after birth. Undescended testicles can be unilateral or bilateral.

Are There Types of Undescended Testicles?

Yes, there are.

1. Palpable undescended testicles constitute 80% of patients with undescended testicles.
   1. 1. True undescended testicles
      2. Ectopic Testicles
      3. Retractile Testicles
      4. Assending Testicles
2. Non-palpable undescended testicles constitute 20% of patients with undescended testicles.
   1. 1. Intraabdominal (located in the abdomen) undescended testicle
      2. Canalicular undescended testicle
      3. No testicle at all

Figure: Some places where testicles can be found in an undescended testicle

 

True undescended testicle: The testicle being anywhere on its normal path of descent and not descending into the scrotum.

Ectopic Testis: The testicle being somewhere other than its normal path of descent and not descending into the scrotum. For example, penile, perineal or in the opposite scrotum (scrotum).

Retractile Testis; It is known as the shy testicle among the public. The testicle is easily descended into the scrotum during examination and remains in the scrotum (scrotum). However, when examined in the cold or with cold hands, the testicle is seen above and is confused with a true undescended testicle. The testicle is seen in the scrotum when it is hot or when taking a bath. These patients do not need to undergo surgery. However, specialist physician follow-up is required at certain intervals.

Assending testicle: The testicle is normally in the scrotum and then moves upwards.

Why Do Testicles (Ovaries) Not Descend into the Scrotum or Move Up Again?

The exact cause is unknown. However, there are some theories that have been put forward. These are usually theories related to nerves or hormones.

Is Undescended Testicle a Familial or Genetic Disease?

It is not. However, if the father has it, the frequency of its occurrence in children or in other siblings is more common than in normal children.

Who is Undescended Testicle More Common in?

It is more common in low birth weight and premature babies and in children with undescended testicles in the family. For example, if the father has a history of undescended testicles, the probability of its occurrence in his children is higher than normal.

What kind of damage is seen when undescended testicles are not operated on?

The testicles are protected in the bag they are in at a temperature 0.5-1 C0 degrees lower than normal body temperature. This condition is necessary for the normal development and functions of testicular cells. It has been determined that the cells in the testicles, which are at body temperature, are irreversibly damaged starting from the 6th month.

Various studies have indicated that 4-12% of testicular tumors originate from undescended testicles. Therefore, it is important to recognize undescended testicles in a timely manner.

If these patients are not operated on, the fertility rate (i.e. the possibility of having children when they get married) is considerably lower than normal patients or patients who have been operated on.

In addition, facility torsion and trauma are more common, on the other hand, some psychological effects may be seen when the patient grows up.

What is the Relationship Between Inguinal Hernia and Undescended Testicles?

The main cause of inguinal hernia in children is the openness of the abdominal membrane accompanying the testicles. Especially in premature babies, both undescended testicles and inguinal hernias can be present together. The risk of damage to the testicles is higher in babies with inguinal hernias.

When is Surgery Performed for Undescended Testicles?

A period of time may be waited for the testicles to settle into the scrotum. The preferred age for surgery is between 6 months and 1 year. It is especially recommended not to exceed 2 years of age because the risk of damage to the testicles increases as age progresses.

Is There a Treatment Method Other Than Surgery for Undescended Testicles?

Hormone therapy can be applied to selected patients. However, the patients who will receive hormone therapy and the treatment dose should be determined well. When hormone therapy is given to the wrong patients, temporary improvement may occur and then relapse. It should also be remembered that high-dose and long-term hormone therapy have serious side effects.

Could Undescended Testicle Be a Symptom of Another Disease?

Undescended testicle is usually an isolated disease on its own. However, undescended testicle and inguinal hernia often occur together. In addition, hypospadias (the urinary opening being down) requires a detailed examination of the patient. It may also accompany internal-external urinary tract and kidney problems. More importantly, in patients whose bilateral testicles cannot be felt during examination, attention should be paid to gender anomaly (Dichotomy).

How is Undescended Testicle Surgery Performed?

Undescended testicle surgery is usually performed as an out-patient surgery. The patient's surgical preparations and tests are performed, and the surgery is performed on the same day. The patient can be discharged 4-6 hours after the surgery.

What is Done Before Undescended Testicle Surgery?

First of all, a good history should be taken and a general physical examination should be performed; only the groin area should not be examined. Then, the family (mother and father) should be well informed about the process, that is, before the surgery, during the surgery and after. If the child is older, the child is also included in this. A number of tests are performed, these tests are not general and are determined according to the patient. and the patient is also seen by the anesthesiologist, the family and the child are informed about the anesthesia process that will be experienced. The patient is left hungry for 4 hours before the surgery.

What is the Recovery Period After Undescended Testicle Surgery?

The patient is fed in accordance with the doctor and / or nurse's directions 2 hours after the surgery. The patient can usually be sent home after 4-6 hours. After the surgery, the patient only takes painkillers in accordance with the doctor's recommendations, there is no need to take additional medication. The patient is seen by the doctor after 48-72 hours, there is no need for dressing during this time, the stitches dissolve on their own and do not need to be removed. The patient continues his normal active life in accordance with the doctor's recommendations after the surgery.

How is Undescended Testicle Diagnosed?

It is usually noticed by doctors during the postnatal examination. Sometimes the family may notice it.

Are Additional Tests Required to Finalize the Diagnosis of Undescended Testis?

Scrotal ultrasonography is performed on every patient to be used in diagnosis and follow-up. Other tests (abdominal USG, hormone tests, Laparoscopy) are performed according to the physician's decision and the examination findings of the testicle.

Is MRI Required for the Diagnosis of Undescended Testis?

MRI can be performed. However, it should be kept in mind that there may be false negatives and that children will receive general anesthesia during the scan in order to perform MRI. We recommend Laparoscopy for both diagnosis and treatment in these patients.

Is a 2nd Surgery Required in Undescended Testis Surgeries?

It may be necessary especially in facilities where undescended testes are not palpable.

What are the Risks of Undescended Testis Surgeries?

Since the patient will receive general anesthesia during the surgery, there may be anesthesia risks, and the patient's relatives are informed about this by the anesthesiologist physician before the surgery.

There may also be some surgical complications (such as wound infection, bleeding, ductal injury, recurrence of undescended testicle and testicular necrosis and loss).

***The information provided here, the content of the website, is designed to inform visitors, especially families. No information should be considered as advice by visitors and should not lead to any decision or action. Families should definitely have their patients examined by a pediatric surgeon, consult with him and make a decision based on his/her personal knowledge.