A testicle that has not shifted into its correct place in the sack of skin hanging below the penis (scrotum) before birth is known as an undescended testicle (cryptorchidism). Typically, only one testicle is damaged, although around 10% of the time both testicles remain undescended.
An undescended testicle is unusual in general, although it is prevalent in preterm infant males.
The undescended testicle usually moves into the appropriate position on its own within the first few months of life. If your son's undescended testicle does not heal on its own, surgery can move the testicle into the scrotum.
WHAT ARE THE SYMPTOMS OF UNDESCENDED TESTICLE?
The major indication of an undescended testicle is not seeing or feeling a testicle where you would expect it to be in the scrotum.
During fetal development, the testicles form in the abdomen. During the last few months of normal fetal development, the testicles progressively descend from the abdomen into the scrotum via a tube-like pathway in the groin (inguinal canal). That process is stopped or delayed in the presence of an undescended testicle.
When should you see a doctor?
When your infant is inspected immediately after delivery, an undescended testicle is usually discovered. If your kid has an undescended testicle, ask the doctor how frequently he should be inspected. If the testicle hasn't shifted into the scrotum by the time your son is four months old, the condition is unlikely to resolve on its own.
When your son is a baby, treating an undescended testicle may reduce the chance of issues later in life, such as infertility and testicular cancer.
Older males, ranging in age from babies to pre-adolescents, who have regularly descended testicles at birth, may subsequently seem to be "missing" a testicle. This situation might mean:
- A retractile testicle that glides back and forth between the scrotum and the groin and may be readily directed into the scrotum by touch during a physical examination. This is not unusual and is caused by a scrotal muscle reaction.
- An ascending or acquired undescended testicle that has "returned" to the groin and cannot be easily directed into the scrotum by hand.
Talk to your son's doctor if you detect any changes in his genitals or are worried about his growth.
WHAT ARE THE CAUSES OF UNDESCENDED TESTICLE?
It is unknown what causes an undescended testicle. A mix of genetics, maternal health, and other environmental variables may interfere with the hormones, physical changes, and nerve activity that regulate testicular development.
WHAT ARE THE RISK FACTORS FOR UNDESCENDED TESTICLES?
The following factors may increase the likelihood of an undescended testicle in a newborn:
- Fetal conditions that can limit development, such as Down syndrome or an abdominal wall defect
- Mother's alcohol consumption during pregnancy
- Mother's cigarette smoking or secondhand smoke exposure
- Low birth weight
- Premature delivery
- A family history of undescended testicles or other genital development issues
- Pesticide exposure in parents
WHAT ARE THE COMPLICATIONS OF UNDESCENDED TESTICLES?
Testicles must be somewhat lower than normal body temperature in order to mature and operate appropriately. This colder climate is provided by the scrotum. Complications of a testicle not being where it should be include:
- Testicular cancer: Testicular cancer generally starts in the cells that create immature sperm in the testis. It is uncertain what causes these cells to evolve into cancer. Men who have had an undescended testicle are more likely to get testicular cancer.
The risk is higher for undescended testicles in the belly rather than the groin, especially when both testicles are involved. The risk of future testicular cancer may be reduced, but not eliminated, by surgically repairing an undescended testicle.
- Fertility issues: Men who have had an undescended testicle are more likely to have low sperm counts, poor sperm quality, and impaired fertility. This can be caused by aberrant testicular development and may worsen if left untreated for a lengthy period of time.
Other issues associated with the undescended testicle's aberrant position include:
- Testicular torsion: Torsion of the spermatic cord, which comprises blood vessels, nerves, and the tube that transports sperm from the testicle to the penis, is known as testicular torsion. This painful disorder prevents blood from reaching the testicle.
If not treated quickly, this can result in the loss of the testicle. Testicular torsion develops 10 times more commonly in undescended testicles than in normal testicles.
- Trauma: Pressure against the pubic bone may cause testicle injury if it is placed in the groin.
- Inguinal hernia: A part of the intestines can push into the groin if the opening between the abdomen and the inguinal canal is excessively loose.
HOW IS UNDESCENDED TESTICLE DIAGNOSED?
If your kid has an undescended testicle, his doctor may advise him to have surgery for diagnosis and possible treatment:
- Laparoscopy: A tiny camera-equipped tube is introduced through a small incision in your son's belly. A laparoscopy is performed in order to detect an intra-abdominal testicle.
The doctor may be able to repair the undescended testicle during the same treatment, but in certain circumstances, further surgery may be required. Laparoscopy may also reveal no testicle or a tiny remnant of nonfunctioning testicular tissue, which is subsequently removed.
- Open surgery: In certain circumstances, direct examination of the abdomen or groin via a bigger incision may be required.
If the doctor cannot detect any testicles in the scrotum after delivery, he or she may order further testing to see if the testicles are not there at all rather than undescended. If undetected and mistreated, several illnesses that result in missing testicles can cause major medical complications soon after birth.
Ultrasound and MRI scans are typically not suggested for identifying an undescended testicle.
WHAT ARE THE TREATMENTS FOR UNDESCENDED TESTICLE?
The treatment's purpose is to relocate the undescended testicle to its normal place in the scrotum. Treatment before the age of one year may reduce the chance of undescended testicular problems such as infertility and testicular cancer. Although earlier is preferable, surgery should take place before the kid is 18 months old.
Surgery
Surgery is frequently used to rectify an undescended testicle. The surgeon inserts the testicle into the scrotum and sutures it in place (orchiopexy). This treatment can be performed with either a laparoscope or open surgery.
When your kid undergoes surgery will be determined by a variety of factors, including his health and the difficulty of the procedure. Your surgeon would most likely advise you to have the operation when your youngster is between 6 and 12 months old. Early surgical intervention tends to reduce the likelihood of future problems.
The testicle may be underdeveloped, abnormal, or dead tissue in rare situations. This testicular tissue will be removed by the surgeon.
If your boy has an inguinal hernia in addition to the undescended testicle, the hernia will be corrected during surgery.
Following surgery, the testicle will be monitored to ensure that it continues to develop, function well, and remains in position. Monitoring might involve the following:
- Physical examinations
- Ultrasound exams of the scrotum
- Hormone levels tests
Hormone treatment
Hormone therapy entails injecting human chorionic gonadotropin (HCG). This hormone has the potential to induce the testicle to migrate to your son's scrotum. Hormone therapy is rarely advised since it is far less effective than surgery.
Other treatments
If your kid is missing one or both testicles, or if one or both did not survive surgery, you may want to investigate saline testicular prosthesis for the scrotum, which can be placed during late childhood or adolescence. The scrotum seems normal with these prosthesis.
If your son does not have at least one healthy testicle, his doctor will refer him to a hormone expert (endocrinologist) to discuss future hormone therapy that may be required to induce puberty and physical maturity.
Results
The most frequent surgical method for treating a single descending testicle, orchiopexy, has a near-perfect success rate. Fertility following surgery for guys with a single undescended testicle is practically normal, but drops to 65% in men with two undescended testicles. Testicular cancer can be reduced but not eliminated with surgery.
HOME REMEDIES FOR UNDESCENDED TESTICLE
Even after corrective surgery, it is critical to monitor the status of the testicles to guarantee appropriate development. You may assist your son by keeping track of his physical growth. During diaper changes and baths, check the location of his testicles on a frequent basis.
When your kid is approaching puberty and you're discussing the physical changes he might expect, explain how he can examine his testicles himself. Self-examination of the testicles will be a crucial skill for detecting potential malignancies early.