Undescended Testis In Children

What is an Undescended Testis?

An undescended testis is a defect that happens before birth when a testicle has still not moved to its correct position, which is the scrotum or the bag of skin hanging below the penis.
This condition usually affects one testicle, but, in a few cases, the condition may effect both testicles, thereby keeping them undescended.
An undescended testis is commonly seen in premature male child.
In most cases, Undescended testis gets rectified on its own, as the undescended testis moves to its appropriate position within the first few months of life.
However, if this condition is not corrected on its own till 6 months of age, then a surgery is required to move the testicle in to its correct position.

What are the signs or symptoms of an Undescended Testicle

If you cannot see or feel a testicle in the baby’s scrotum, then this may be due to an undescended testicle.
When the foetus is still developing, testicles are formed inside the abdomen.
In normal development of the foetus, the testicles descend from the abdomen, into the scrotum, through the tube-like passage, into the groin (inguinal canal).
The above process, happens in the last couple of months of normal foetal development. When this process is halted or delayed, it leads to the condition called Cryptochordism or Undescended Testicle.

When should you consult a doctor an undescended testicle ?

An undescended testicle gets identified in the post birth examination of the baby boy.
If this happens, the baby boy will need to be examined regularly, and you should check with your doctor on the frequency of the baby boy’s examination.
It is often noticed, that if the testis has not moved to the scrotum within 6 months, chances are, the condition may not get rectified on its own.
Getting the baby boy treated for undescended testicle may lower the risk of complications in the future, like testicular cancer and infertility.
Some boys may have been born with normal testicles at birth, but the same might appear missing later. This may happen due to the following reasons:

  • Retractile Testicle – In this, the testicle moves back and forth, between the scrotum and groin. This may happen due to a muscle reflex in the scrotum, and may be easily guided into the scrotum with the hand, during the physical examination.
  • Ascending testicle – In this condition, the testicle moves back to the groin and cannot be guided back to the scrotum with the hand. This is also called acquired undescended testicle.

The corrective surgery is orchidopexy means fixing the testis in scrotum. The testis lying inside the abdomen needs laparoscopic orchidopexy.
It is best to speak to your paediatrician or doctor if you see any changes in your son’s genitals or are concerned about his developments.
To book an appointment with Dr. Prashant Jain, the best paediatric surgeon in Delhi, Call (+91) 8766350320.

Risk factors of Undescended Testicles

Factors that might increase the chances of having an undescended testicle are:

  • Premature birth of the baby boy
  • Low birth weight of the infant

Complications associated with Undescended Testicles

Testicles need to be cooler than the normal body temperature, so they can develop and function normally. This environment is provided by the scrotum. In case of an incorrect placement of the testicle, following are the complications that may arise:

  • Testicular Cancer – develops in the cells of the testicles that produce immature sperms. Men with undescended testicles are at a higher risk of having testicular cancer. This risk increases if the testis is located in the abdomen instead of the groin, and when both testicles are affected. While the cause of cells developing into testicular cancer is still unknown, surgical correction may reduce the chances but does not eliminate the risk completely.
  • Fertility problems – Men with undescended testicles may develop low sperm count, poor quality sperm and reduced fertility the condition is ignored or left untreated for a long time.
    Other complications associated with Undescended testicles are:
  • Testicular Torsion – This condition is painful as it cuts off the blood supply to the testicle. This happens when the spermatic chord, which contains blood vessels, nerves and the tube which carries semen, gets twisted. If left untreated, it may result in the loss of the testicle. Men with Undescended Testicles are ten time more prone to testicular torsion than the ones with normal testicles.
  • Inguinal Hernia – Happens when a part of the intestine pushes into the groin, if the opening between the abdomen and the inguinal canal is too loose.
  • Trauma – The testicle may be prone to damage from the pressure against the pubic bone, if it is located in the groin.

To know more or to book an appointment with Dr. Prashant Jain, the best paediatric surgeon in India, Call (+91) 8766350320.

Diagnosis of Undescended Testicle

 Doctors may recommend the following types of surgery for the diagnosis and treatment in case of an undescended testicle.

  • Laparoscopy – Laparoscopy helps find out an intra-abdominal testicle. A small incision is made in the abdomen, post which, a small tube containing a camera is inserted.
    In some cases, an additional surgery may be needed if the doctor cannot rectify the testicle’s 
    position during laparoscopy.
    In case laparoscopy shows the absence of a testicle or a small remnant of the testicular tissue,  then the same is removed.
  • Open surgery – This type of a surgery, requires a slightly bigger incision when testis is lying in groin.
    Post the birth of a boy, if the doctor notices that the boy’s testicles are missing in the scrotum,  he may do a few tests to see if the testicles are undescended or are absent.
    If left untreated or undiagnosed, absence of testicles may cause serious medical problems post  birth.
    It is not recommended to go for an ultrasound or an MRI for the diagnosis of an Undescended  Testicle.

Treatment of an Undescended Testicle

Treatment helps in moving the undescended testicle in to it’s appropriate position in the scrotum.
It is recommended that surgical intervention happens before 18 months of the child’s age. Earlier the treatment happens, better it may be, as treating the infant before one year, may reduce complications.
Following are the different treatment for Cryptochordism or Undescended Testicle:
Surgery
The process of the surgeon, moving the testicle back into the Scrotum and stitching it to place, is called Orchiopexy. Laparoscopy or surgery is used to carry out this process.
A number of factor’s, such as, the infant’s health or the level of the surgery’s complication, may determine how soon the surgery or correction of the undescended testicle can be carried out.
The surgery may be recommended when the child is between 6-12 months old. Early surgery reduces the risk of complications in the future.
The surgeon removes the tissue, in case he sees that the tissue has not developed properly or is an abnormal or a dead tissue.
The surgery also repairs an Inguinal Hernia that may occur due to the Undescended Testicle.
Post surgery, the testicles are regularly monitored to confirm if it is staying in place and is developing properly. This is done through physical exams, Ultrasound examination of the scrotum and by testing of hormonal levels.

Other Treatments

Saline Testicular Prosthesis treatment, which gives the scrotum a normal appearance, may be considered, if one or both testicles are missing or did not survive post surgery.
An Endocrinologist or a hormone specialist may be referred if the child does not have even one testicle which is healthy.
Endocrinologist helps with future hormone treatments that are necessary to bring about puberty and physical maturity.
Results
Orchiopexy, mostly has a 100% success rate. Post surgery, the fertility for males with Undescended Testicle is nearly normal, however, for males with two Undescended Testicles, the chances are 65%.
While surgery might reduce the risk of testicular cancer, it still does not eliminate it.

Lifestyle changes and remedies at home for Undescended Testicles:

It is important to ensure that the testicles are developing normally, even after the child’s surgery. Being aware of the development of your son’s body and checking the position of his testicles regularly, helps him in the long run. This can be done while changing the diaper or while bathing him.
Talk to your son about the physical changes that are about to happen, when he reaches puberty.
Teach and encourage him to check his testicles regularly, as self-examination can help with the early detection of tumors.
How to cope with and support your son with Undescended Testicle Your son may be uneasy or sensitive about looking different, especially if he has to change his clothes in front of his friends or classmates, in a sports or in a school drama changing room. Guide him with the following tips, to help him deal with anxiety

  • Practice him to come up with a response if he is asked or teased about his condition
  • Let your son know that he is healthy, even if one or both the testicles are missing, and that there are two testicles in the scrotum
  • Teach your son to use the right words when he is talking about testicles or scrotum
  • To make the condition less noticeable, let your son wear loose-fitted swimming trunks or boxer shorts, so he is comfortable while changing clothes in front of others
  • Be watchful or aware of any behavioural changes, like not enjoying the sports or activities he he earlier used to
  • Speak to him about testicular prosthesis and discuss if it is a good option for him

What to ask your doctor if your son has undescended testicles

 An undescended testicle is a birth defect, and is identified in the post birth examination. This condition is monitored through regular examination of your infant. Here are a few questions that you can ask your family doctor or your paediatrician:

  • What are the different tests that my son will need to undergo?
  • Which option would you recommend as a treatment?
  • Can you recommend a specialist, to whom i can show my son’s condition.
  • to build my knowledge about my son’s condition, can you recommend a few websites or give me some brochures that i can read at home
  • How frequent should my son’s appointments be?
  • To monitor any changes in the undescended testicle, how can i examine the scrotum at home?

What to expect from your doctor

If the testicle is missing from the scrotum, the doctor uses a lubricant or warm soapy water and tries to find it during the examination by pressing against the child’s skin.
The doctor tries to move the testicle gently in to the scrotum, if he finds it in the inguinal canal. If the testicle moves easily back to the scrotum and remains there for a while, it is most likely a retractile testicle.
If the testicle moves only partially and causes any pain or discomfort during the movement, or if it comes back immediately to the original location, it might be an undescended testicle.
A paediatric urologist who specialises in children’s genital and urinary tract disorder, or a paediatric surgeon may be recommended for further examination if the testicle does not descend or cannot be located by the time the child is 6months old.
Dr. Prashant Jain, is a renowned Paediatric Laparoscopic Surgeon in Delhi. To book an appointment call (+91) 8766350320.

Laparoscopic orchodopexy by Dr Prashant Jain

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