The most common testicular pathologies in boys are undescended testis (testicle not in the bag), hydrocele (Water Hernia) and varicocele.
It is one of the most common diseases in pediatric urology. It is seen in 3% of a term baby and 1% around 1 year of age. It can be seen bilaterally in 10-25% of cases. Born before 37 weeks and <2500 g. Babies born at risk for undescended testicles.
Acquired undescended testis cases are encountered around 2 years and 8-10 years of age in previously normal children. While 80% of the undescended testicles are palpable, 20% are not. While 20% of these testicles are palpable under anesthesia, the rest are normal or smaller than they should be in the abdomen.
What happens if the testis has not descended into the bag?
When the testis does not descend, the number of Leydig Cells responsible for testosterone secretion and the dimensions of the seminiferous tubule, which has an important place in sperm formation, decrease. Since these testicles are exposed to 2-4 degrees extra temperature, 2% of the germ cells responsible for sperm formation are damaged for each month the testicles are above, while 1% of the Leydig cells responsible for Testosterone production are lost.
Testosterone production continues in unilateral undescended testicles and these children enter puberty, the other testicle takes over the role of the affected one in terms of fertility. Delayed treatment in bilateral undescended testicles is a serious cause of infertility.
All of the non-operated patients with bilateral undescended testicles are azoospermic (when there is no sperm cell in the spermiogram), and 20% of the operated patients have normal sperm parameters. The earlier the treatment, the better the sperm parameters and testicular growth.
Sometimes I See The Testicle In The Bag Sometimes Above
This condition is called retractile testis (colloquially shy testis). Overactivity of the Kremester muscles is held responsible. 10-50% of these testicles are misdiagnosed as undescended testicles. Annual follow-up is recommended for retractile testicles. Approximately 30% of these may become undescended testicles within three years and may require surgery.
What Happens If Undescended Testicle Is Not Operated?
Children with undescended testicles have to undergo surgery for the following reasons;
It is a painless collection of fluid in the scrotum (the bag in which the testicles are located). When the baby is in the womb, the testicles are in the baby’s abdominal cavity during their formation. It completes its descent into the scrotum near birth, closing its connection with the intra-abdominal cavity. Although the testicles descend into the scrotum in hydrocele, this connection is not closed. From time to time, fluid enters the scrotum through the abdomen and there is an increase in scrotum size, especially later in the day. If the connection is small, it is only accompanied by the collection of fluid in the scrotum, if the connection is wide, the small intestines can pass here and cause a hernia.
Diagnosis is made by physical examination and, if necessary, by ultrasound guidance.
What is the Treatment
It usually disappears on its own within the first year. Therefore, babies born with hydrocele are not operated immediately and are followed up. If the scrotal swelling does not decrease and disappear afterward, surgical treatment is planned. This is usually done after 12-18 months.
Is the Surgery Difficult?
It is an outpatient surgery performed with a 2 cm incision from the inguinal region under general anesthesia.
Varicocele is defined as the enlargement of the veins coming from the testis. It is detected at a rate of about 15% in adolescence and may cause progressive damage to the testis. It is one of the leading causes of male infertility that can be corrected by surgery.
Varicocele is present in 20-30% of men who apply for infertility at later ages.
What causes varicocele
Temperature increase in the testis, insufficient oxygen, reflux of harmful substances in the kidney and adrenal gland to the testis can cause testicular shrinkage and infertility due to ROS and Oxidative Stress.
How to Diagnose
Diagnosis is made by physical examination before and during puberty.
It is evaluated at 3 degrees.
Grade 1: Enlarged testicular veins that are palpable only after straining
2nd Degree: Veins that are palpable without straining on the feet but not noticed from the outside.
3rd Degree: Veins that are visible from the outside.
The diagnosis of varicocele can be proven with scrotal Doppler USG and at the same time, the risk factor can be defined according to the difference in both testicles by measuring the testicular dimensions.
The difference in size and consistency between the patient’s testicle on the side with varicocele and on the other side is important. If there is a difference in consistency between the 2 testicles on physical examination and a difference in size between the two testicles in measurements, it indicates that the patient is at risk for infertility.