Undescended Testis
Overview
More commonly referred to as an undescended testicle, cryptorchidism can be a serious medical condition. It is characterized by a testicle that has not moved into the scrotum before birth.
The condition is not very common. It occurs most frequently in prematurely born male babies. Typically, cryptorchidism only affects one testicle. However, both testicles are undescended in about 10 percent of cases.
Fortunately, most cases of cryptorchidism resolve on their own. During a child’s first few months of life, the testicle will descend into the scrotum without any medical intervention.
If your son has cryptorchidism, medical professionals can correct the problem with a surgical procedure. Generally, physicians give the testicle ample time to drop on its own so that they do not subject the child to an unnecessary surgery.
However, if your child experiences complications, then medical staff may need to move forward with surgical intervention sooner.
Symptoms
The primary symptom of cryptorchidism is the inability to locate both testicles. If one of your son’s testicles cannot be felt or seen, then it is likely undescended. That is because the natural descent process was delayed while your child was in the womb.Diagnosis
If the doctor cannot locate both of your son’s testicles in the scrotum, then they may recommend additional testing. This testing will determine if they are undescended or missing entirely. Certain medical conditions that result in the absence of testicles can lead to serious medical complications if left untreated.
Imaging tests are generally ineffective at diagnosing cryptorchidism. Instead, physicians often recommend surgical procedures to diagnose and treat the condition. The preferred method is a procedure known as laparoscopy.
Laparoscopy
During a laparoscopy, the physician will make a small incision in your child’s abdomen. They will then insert a tiny camera into the incision. This procedure is necessary to locate an intra-abdominal testicle.
Sometimes, the physician can fix the undescended testicle during the same procedure. However, more invasive procedures are necessary in some cases.
Treatment
Undescended testicles are typically treated through surgical intervention. While some testicles will descend on their own, it is vital that treatment does not get delayed for too long. Surgical intervention before your child turns one may lower the risk of future complications, such as infertility. At the latest, your child should undergo corrective surgery before 18 months of age.
Surgery
During surgery, the physician will carefully relocate the testicle into the scrotum. They will stitch it into place so that it does not ascend again. This specific procedure is known as an orchiopexy.
Orchiopexies can be completed laparoscopically in most cases. However, some children require open surgery. Undescended testicles may also involve an inguinal hernia. If so, both conditions can be resolved during a single surgical procedure.
After the surgery, your child’s physician will monitor the testicle to ensure normal development and function. This may include ultrasounds, tests of hormone levels, and physical exams.
Orchiopexy
For patients that have an undescended testicle, surgical intervention may be recommended. Depending on the age of the patient and positioning of the testicle, your physician might suggest a procedure called an orchiopexy to bring the testicle into the correct position in the scrotum. During this procedure, the testicle is moved into the scrotum, and some attachments holding it further up into the groin or abdomen are removed or divided. If the testicle is not palpable on exam in the groin or near the scrotum, your doctor will likely suggest further imaging prior to any procedure.
Most cases of undescended testicle that would require this procedure are diagnosed in childhood. For adult patients, there is usually limited benefit to proceed with an orchiopexy. Removal or observation of an undescended testicle is typically recommended, depending on size and location of the testicle, as well as the age of the patient.
Surgery may require a small incision in the groin, or a more advanced procedure with intra-abdominal laparoscopy to locate the testicle if it is not palpable in the groin.
Recovery usually consists of some light activity for a few weeks, and may require low doses of narcotic medications for post-operative pain.
FAQ's
Your child should not experience pain from an undescended testicle. However, there are other risks to their normal development if the condition is left untreated.
Imaging equipment such as X-ray machines are not effective for diagnosing or evaluating undescended testicles. Doctors cannot locate undescended testicles by hand, either. Instead, they may need to perform a minimally invasive laparoscopy to determine whether your child has an undescended testicle.
Fortunately, many undescended testicles will move into place on their own. However, if this has not occurred by your child’s first birthday, then surgery will likely be recommended. Surgical intervention is the best way to protect your child from complications related to the condition. The surgery is known as an orchiopexy.
An orchiopexy moves your child’s undescended testicle into the scrotum, where it is a few degrees cooler. This promotes fertility later in life. However, some children may still be infertile due to undescended testicles.
By putting your child’s testicles into the scrotum, it is easier to detect abnormalities like testicular cancer. Children that are born with an undescended testicle are at a slightly elevated risk of developing testicular cancer.
Yes, your child’s scrotum should look completely normal. In some cases, the undescended testicle consists of dead or damaged tissue and must be removed. When this happens, you can opt to have a prosthetic testicle placed into your child’s scrotum.