Testis not descended

In young boys, we sometimes notice an undescended testicle. Surgical treatment may be necessary.

Your child has been diagnosed with an undescended testicle (cryptorchidism). This condition occurs in about four percent of newborn boys. The testicles, organs that produce male hormones and sperm, first develop in the abdomen, close to the kidneys. During their growth, before the boy’s birth, they gradually descend to the scrotal bag through the groin.

Related issues

Infertility (difficulty procreating) has often been associated with a lack of descent of the testes.

The risk of infertility is minimal in cases where a single testicle has not descended but more important when it comes to the two testicles.

The percentage of fertility is increased when the testis descended into the scrotum before the age of 2 years.

A defect of descent of the testicles is often associated with hernias. Sometimes these hernias cause a descent of the intestines to the groin and the scrotum. These hernias are easily repaired at the time of surgery to lower the testicle.

An undescended testicle presents a higher risk of testicular tumor that usually appears after adolescence. This rare type of cancer is more common in men with an undescended testicle. An operation to lower the testicle to the scrotum does not diminish the risk of cancer, however, an early diagnosis is possible by examining the testis. The sooner the tumor is diagnosed, the greater the chances of recovery. An undescended testicle is more prone to injury, especially when it is in the groin.

In addition, the appearance of a normal scrotum containing two testicles may be important for the boy’s self-esteem, especially during adolescence. For all these reasons, it is important to correct a testicular descent defect.

investigations

When the physical examination reveals an undescended testicle, usually located in the groin, no further examination is indicated. If the testicle can not be located, it must be determined whether or not it exists. In some children there is a complete absence of testis; in others, developmental arrest can be observed before birth, often due to lack of blood supply.

An ultrasound can locate the testicle in the abdomen or groin. In some cases, the abdominal cavity under anesthesia (laparoscopy) will be examined using an instrument passed through the umbilicus to visualize a testicle that can not be detected otherwise.

Treatment

Surgical correction of an undescended testicle (orchidopexy) is most often recommended before the age of 2 years. This is a day surgery, under general anesthesia (the child is asleep). A small incision is made in the groin and the testicle is released from its attachments. It happens that the testicle is badly formed, in which case it is better to remove it. An artificial testis can be placed in the scrotum, if appropriate, to give the scrotum a normal appearance.

When there is hernia, it is repaired. To do this, the surgeon will make a small incision in the scrotal bag to make space for the testicle. Once the testicle is placed in the scrotum, the two incisions are closed by melting points. A dressing can be placed on the incisions. In some cases, the descent of one or both testicles may be interrupted, the testicle stopping its descent between the abdomen and the scrotum. This condition is usually observed from the medical examination of the newborn.

An undescended testicle can descend to the scrotum itself during the first months of life of the child. It is rare to observe a spontaneous descent of the testicle after the age of one year, so your urologist will probably recommend that your child will be able to go home when he wakes up, hopefully.

Surgery is beneficial in 90 percent of cases. Sometimes, poor blood drainage of the testis can lead to growth failure or lack of testis. Sometimes the testicle that has been surgically returned to the scrotum slides back to the groin, most often in the weeks following the operation. A second operation may be recommended to correct this problem.

In some cases, hormonal treatment may be effective. HCG, administered as injections in the buttocks, stimulates the production of male hormones (testosterone) and promotes the descent of the testis. HCG, on the other hand, can give reversible side effects due to hormones, such as enlargement of the penis, the appearance of down in the pubic area, more frequent erections and redness of the scrotal skin. The schedule of injections can be changed, but usually six or eight injections

The Urological Association of Canada has prepared this booklet. Surgical incisions for orchidopexy administered over a period of three to four weeks are required to achieve the descent of the testis. This treatment has limited effectiveness.

Monitoring

Your child will be seen followed by his urologist a few weeks after his surgery to check that healing is normal. He will then be returned to the care of your family doctor or pediatrician. Despite the success of the operation you must remember that your boy is always at risk of developing a testicular tumor. Your family doctor or pediatrician will check your child’s testicles periodically, and as a teenager, a self testicle test should be taught to him.