Undescended Testicle

Undescended testicle, also called cryptorchidism is a condition in which a boy’s testis fails to come down to the scrotum (bag of skin that carries it).

Many boys are born with this condition. Generally, only one testicle is affected, but in 1 out of 10 cases both the testicles are affected.

The condition is common in premature babies. The majority of the cases resolve on their own within first few months after birth.

If an undescended testicle in your baby does not normalize on its own, surgery may be considered to correct the condition.

The first symptom that indicates your baby has undescended testicle is when you do not see or feel a testicle in its normal position.

During fetal development, the testicles form in the abdomen, from where it gradually moves downwards through inguinal canal (a tunnel-like structure in the groin) into the scrotum.

When this process is interrupted or delayed, the condition occurs.
Typically, most cases are identified shortly after birth during a routine examination. Wait for some months and schedule regular appointments with your doctor to report any changes.

If the condition does not resolve within 4 months, it is most likely that the problem will prevail. Talk to your doctor about this.

If you treat the condition when your son is still a baby, it is more likely that the baby won’t have later-life complications such as infertility and testicular cancer.

In some case, boys with normal testes at birth may apparently find their testicle "missing" later in life. It could be due to:

Retractile testicle: a condition called in which the testicle can move to groin and come back again into the scrotum. It’s a normal condition and occurs due to a muscle reflex in the scrotum.

Acquired undescended testicle or an ascending testicle: A condition in which the testicle moves to the groin and doesn’t easily come back to the scrotum.

Talk to your doctor if you notice any abnormal positioning of the testis in your baby.

It’s not clear what causes an undescended testicle. Various factors that affect processes during testicle development may cause the testicles to be placed in the wrong position inside the scrotum.

Some of these factors are hormones, physical changes and nerve activity, which in turn are affected by your genes, mother’s health during pregnancy and other environmental factors.

Generally, your doctor makes a diagnosis of undescended testicle immediately after birth. The condition is monitored periodically during regular or scheduled visits.
Getting prepared for the visit can optimize the therapy and help make the visit more fruitful.

List out all the symptoms. Write down your key medical information. Make a list of the questions to ask your doctor.

Some typical questions can be:

• How often do I need to schedule appointments?
• Can you recommend me some examination techniques to identify changes in the undescended testicle?
• Do I need to see a specialist?
• What tests does my son need?
• What are the treatment options available?

A clear talk with your doctor can optimize the therapy and improve the outcomes. Prepare yourself to better explain your son’s condition to the doctor.

Your doctor will begin the diagnosis by examining your baby's groin. If s/he feels no testicle in the scrotum, s/he or will look for the testicle in other parts of the groin.

Once located in the groin, s/he will try to glide it to the scrotum. This can reveal:

• Undescended testicle if this causes pain, testicle moves partially into the scrotum and immediately returns back to its original position.
• Retractile testicle if the testicle can be glided easily into the scrotum and stays there for a while.
• If your son's testicle hasn't moved to scrotum within 3 or 4 months after birth, your doctor can refer you to a pediatric urologist (specialist in children's genital and urinary tract disorders) or a pediatric surgeon for further examinations.

Surgery may be recommended for diagnosis and potential treatment, which include:

• Laparoscopy: It involves inserting small tube containing a camera through a small incision in your son's abdomen. This can help to determine a location of a testicle inside the abdomen. In the same surgery, your doctor may correct the undescended testicle.

• Open surgery: It is a more invasive procedure and involves opening your child’s belly or groin and scrotum. In some cases, a larger incision may be required.

Treatment makes an attempt to relocate the undescended testicle into the scrotum.

Treatment that starts before 1 year of age helps to minimize the risk of complications such as infertility and testicular cancer.

Surgery

Surgery is often the most effective and widely used treatment for an undescended. The surgeon gently moves the testicle into the scrotum and fixes it into its normal place (orchiopexy).

This procedure may be carried with a laparoscope or with open surgery. The time for surgery is determined by your son's overall health and complexity of the procedure.

Most commonly, surgery is recommended 3 to 6 months after birth and not later than 12 months. Surgery, when performed early, may lower the risk of later complications.

Surgery may also be required to remove a poorly developed, abnormal or dead testicle. If an inguinal hernia is present, it is repaired during the surgery.

Post-surgical monitoring is also necessary, which helps to monitor testicular development.

Monitoring might include:

• Physical exam
• Ultrasound exam of the scrotum
• Tests of hormone levels

Hormone treatment

Human chorionic gonadotropin (HCG) is injected to your child, which may facilitate movement of the testicle into the scrotum. This choice is less favored because of its limited efficiency.

Other treatments

Saline testicular prostheses for scrotum may be considered if one or both the testicles are missing or have been missing after surgery. They can be implanted during late childhood or adolescence.

If both the testicles are missing, or none of the testicles are healthy, you need to consult a hormone specialist (endocrinologist) to address future hormone needs for inducing puberty and physical maturity.

Orchiopexy is a surgery that is most commonly used in boys with the single descending testicle. It is highly successful treatment approach and has a success rate of nearly 100 percent.

Lifestyle modifications are necessary in order to cope with undescended testicle.

Corrective surgery does not always ensure proper development of the testis. You should examine the testicles regularly to look for any changes in the position.

It can be done during diaper changes and baths. Things can be more problematic as your son approaches puberty.

Talk to him about the problem and assure him on how you can help. You may suggest him self-examination of testicles to detect any tumor.

Undescended testicle can cause a storm of anxiety and low self-esteem in your child.

Here are some tips that might help cope better with the situation:

• Teach him that there are usually two testicles in the scrotum.
• If he's missing one or both, explain in simple terms what that means and that he's still a healthy boy.
• Assure him of his identity despite the condition.
• Discuss with him about a testicular prosthesis.
• Tell him ways to handle embarrassing situations like getting teased.
• Suggest him ways to make the condition less noticeable when changing clothes and playing sports such as wearing boxer shorts or swim trunks.

There are several risks and complications associated with undescended testicle.

Risks include:

• Low birth weight
• Premature birth
• Family history of undescended testicle or other problems of genital development
• Conditions of the fetus that can restrict growth, such as Down syndrome or an abdominal wall defect
• Consumption of alcohol during pregnancy
• Cigarette smoking by the mother or exposure to secondhand smoke
• Obesity in the mother
• Diabetes in the mother - type I and II diabetes or a special type of diabetes that occurs in pregnant women (gestational diabetes)
• Parents' exposure to some pesticides

Complications include:

• Testicular cancer. Testicular cancer is the one that develops in the cells of the testicle. Men who have had undescended testicle are at an increased risk of developing testicular cancer. The risk increases if the testicles are located in the abdomen than in the groin. Surgery to relocate the undescended testicle may help to reduce the risk of future testicular cancer. The risk increases if the testicles are located in the abdomen than in the groin. Surgery to relocate the undescended testicle may help to reduce the risk of future testicular cancer.

• Fertility problems: Fertility problems like low sperm counts, poor sperm quality and decreased fertility are more common in men who've had an undescended testicle.
• Testicular torsion: Testicular torsion is a painful condition that occurs when the tube carrying semen from testicle to penis (spermatic cord) rotates. As a result, blood supply to the testicles is obstructed. This condition requires immediate medical care as delayed action can result in the loss of the testicle. Men with undescended testicle are 10 times more likely to have testicular torsion compared to those with normal testicles. As a result, blood supply to the testicles is obstructed. This condition requires immediate medical care as delayed action can result in the loss of the testicle. Men with undescended testicle are 10 times more likely to have testicular torsion compared to those with normal testicles. Men with undescended testicle are 10 times more likely to have testicular torsion compared to those with normal testicles.

• Trauma: The testicle located in the groin might be subjected to damage from pressure against the pubic bone.
• An inguinal hernia: An undescended testicle can weaken the inguinal canal, causing protrusion of a portion of the intestines into the groin.