• What Is Undescended Testicle?
    In males, testicles complete their formation during the first two months of pregnancy and release the hormones that makes the sexual differentiation. On the 7th month of pregnancy, testicles in the abdomen start descending to scrotum with the effect of testosterone. When the labor is close, testicles getting close to scrotum pass the inguinal canal and place themselves in scrotum. When this descension isn’t complete and the testicles remain in the inguinal canal or abdomen, this condition is called undescended testicle. It’s mostly one-sided and sometimes two-sided.


 

How is it diagnosed?

Testicles are felt in the inguinal canal instead of scrotum. Sometimes testicle may not be palpated in this canal as well. Location of the testicle in the abdomen is found with ultrasound or laparoscopy. In this case, sometimes the testicle may be descended to scrotum or decayed testicle is found and taken out in the cases where the testicle is decayed. As a result, undescended testicle may divided into two as palpated or unpalpated..
• Palpated undescended testicle is moved to the scrotum through surgery (inguinal orchiopexy)..
• Laparoscopy or open surgery (exploration) should be conducted for unpalpated testicle (located in the abdomen) and it should be moved into the scrotum (if the scrotum is healthy) or taken out (if the testicle is decayed)..



What Is RETRACTILE TESTICLE (Shy testicle, moving testicle)? Should It Be Operated?

In this condition which is called “shy testicle” or sometimes “nervous testicle” colloquially, testicle or testicles go up to inguinal canal from the scrotum. Typically the testicle moves up with the effect of cold or touch of the child, and it’s seen in the scrotum when it’s warm and when the child is sleeping. Retractile testicle have completed their descendance, it’s a different and simple Situation compared to undescended testicle and sometimes the testicle moves up due to strong reflex contractions. Children with retractile testicle don’t need any surgical or medical treatment. They just should be monitored every 6 month until their puberty period..



UNDESCENDED TESTICLE AND INFERTILITY

Normally, the temperature of scrotum is approximately 2 degrees lower than the body temperature. The testicle that remains in the groin or abdomen (exposed to heat permanently) starts to get damaged. If both testicles are undescended, infertility would be inevitable in the upcoming years (It has been shown in the electrone microscopy that the tissues within the testicles that are consistently exposed to heat get damaged, or in other words seminiferous tubulus gets damaged).
Additionally, structural damage, function loss and atrophy (decay) may develop in the undescended testicle in years. In the cases where this abnormal testicle is left in the body, tumors may develops (malign transformation).
Patients with undescended testicle have 20-25 times more risk to have testicle cancer.


HOW IS THE UNDESCENDED TESTICLE TREATED? WHEN SHOULD IT BE CONDUCTED?

The first treatment for undescended testicle is surgery. Testicle is moved down to the scrotum with an approximately 2 cm section on the inguinal area through an operation called inguinal orchiopexy. The operation takes around half an hour and conducted under general anaesthesia. The patient is release on the same day after the operation. The success rate of the operation conducted by an expert physician is quite high (around 95%). If the testicle is in the abdomen, testicle is found through laparoscopy or open surgery as mentioned above, and the testicle is moved down if healthy and taken out if it has atrophy.

The right time to operation is the age of 1. It should be monitored until then. Hormonal treatment can be tried in some cases around this period. However, the testicle which has been monitored until the age of 1 and is undescended should be moved down through surgery..
Eventually, in the undescended testicle which is a treatable problem through surgery, the family should be very conscious and take their children to a specialist before the child is 1 year old. Since it would almost be impossible for the testicles to go down to scrotum after the age of 1 and atrophy would start developing after the 12th month, it should be treated through surgery before it’s late..

© 2016 - Op. Dr. Cem ÖZLÜK