Causes of undescended testis

Undescended testis is called “cryptorchidism, hidden or undescended testicles”. Although this condition is generally rare, it is usually seen in preterm infants. As the male fetus grows in the womb, the testicles appear and manifest in the abdomen, near the kidneys. In the seventh month of pregnancy, the testicles begin to descend from this region to the groin. They should reach their final position in the scrotum 6 months after birth. The main task of the testicles is to produce the male hormone testosterone and sperm. An undescended testicle can produce hormones, but its ability to produce sperm is greatly impaired. An undescended testis is diagnosed in approximately 1% of 1-year-old boys. It is the most common congenital anomaly of the genital organs in newborn boys. Usually only one testicle is affected, but the probability of both testes not being bred is approximately 10%.

Undescended Testicle Causes: It is not known why some testicles do not descend.

Risk factors include:

Presence of family members with undescended tethys or other concomitant genital organ anomalies

Premature birth or low birth weight

Conditions that affect baby growth in the womb

Mother’s use of alcohol or cigarettes during pregnancy

Long-term or exposure to certain pesticides

Undescended Testicle Types

Undescended testes are divided into two groups as palpable or non-palpable during maye. Approximately 70% of undescended testes are palpable. A palpable undescended testicle may have stopped in any area on the normal descent path. Sometimes the testicle may be located in a place other than the normal descent path (outside the scrotum), this is called an ectopic testicle. In some patients, due to the strong cremaster muscle reflex, the testicles may cause the testicles to move back and forth between the scrotum and the abdomen, this type of testicle is called a retractile testicle. An undescended testicle that cannot be palpated is usually located in an area in the abdomen. It can be located on the genital organs (above the inguinal ring), around the kidney, between the rectum and the bladder or near the stomach wall. The treatment is decided according to the location of the testicles and the presence of testicles. Ectopic palpable testicles require surgery. Retractile testicles that can be manually lowered can be expected until puberty under close monitoring. If both testicles are not palpable and sexual differentiation is appropriate and present; An endocrinological and genetic evaluation should be performed. Patients and their relatives usually apply to the doctor with the complaint of not being able to feel the testicles in the scrotum (bags). The testis is typically found to be absent on a baby’s immediate postnatal examination. During the first 6 months, the undescended testis should be monitored with regular controls. If the testicle does not descend on its own, treatment will be needed.

Diagnosis

Physical Examination: By physical examination, undescended testicles are classified as palpable and non-palpable (palpable/non-palpable). Imaging methods don’t help much in this regard. For examination, the child is placed on his back and the legs are brought in the frog position. If one testicle is non-palpable undescended and the other is larger than normal, one testicle may be absent-underdeveloped or atrophic (small). The abdomen should be visually inspected to ensure that the undescended testis is not ectopic.

Diagnostic laparoscopy: Laparoscopic intra-abdominal examination (camera examination) is the only way to reliably diagnose a non-palpable testis. It is recommended to perform laparoscopic evaluation under general anesthesia, some testicles that could not be palpated before the procedure may become palpable, general anesthesia provides us with this opportunity.

TREATMENT

If the testicle does not descend on its own, it will need treatment. The aim of the treatment is to prevent problems that may occur in sperm and hormone structure and to reduce the risk of testicular cancer, which is 7-14 times more common than normal people in the future. The surgery should be performed around the age of 1 or within the first 18 months at the latest.

Hormonal therapy: In some cases, hormone therapy may be used to allow the testis to descend into the scrotum on its own. However, this treatment is not recommended because surgery is much more effective.

Surgical

Orchidopexy: The basic treatment of undescended testis is surgical removal of the testis into the scrotum (orchidopexy). Almost 100% success is achieved with this surgery. If a testicle has not fully descended into the scrotum in the first 6 months, surgery must be performed within the next 1 year. Delayed treatment may increase the risk of future testicular cancer and/or infertility. Surgery for a palpable testis is done through two incisions: one is made in the area where the testis is located, and the other is in the area where the testicles will be inserted into the scrotum. Laparoscopic examination may be required for non-palpable testis, it is the best way to locate the testis, general anesthesia is required for this. If necessary, complete removal or normal positioning of the testis can be performed by laparoscopy.

Follow-up:

Those who have an undescended testicle in childhood can have children, those who have undescended testicle surgery before 18 months have almost the same chance of becoming a father as a normal man. The risk of developing testicular cancer in children with undescended testicles is very high (7-14 times) compared to other men. Therefore, it is necessary to perform periodic and regular check-ups during and after adolescence in those with a history of undescended testicles. Cases with retractile (descending-ascending) testicles do not require medical or surgical treatment, but should be kept under close follow-up until adolescence.

Suggestions for undescended testicles:

Retractile testicles do not need medical or surgical treatment, but close follow-up until adolescence is required.

The process of lowering the undescended testicles into the scrotum should be done within 1 year or at the latest 18 months.

In patients with non-palpable testicles and when sexual developmental dysfunction is not apparent, laparoscopic examination is the best way to find the test. The testis can be removed or repositioned in the same session.

Hormonal therapy is not a standard treatment.

In children aged 10 years or older, if one testicle is normal and the other testicle is in the abdomen and is not palpable, removal of the testicle may be considered due to the risk of developing testicular cancer later.

Newborn babies whose two testicles are not palpable should be evaluated for possible disorders of sexual development.

Frequently Asked Questions:

one- The pediatrician did not feel my son’s testicles where they should be after birth. What should we do?

Your pediatrician will need to regularly check your child’s genitals. Testes can descend naturally up to 6 months. If it does not go down on its own, he will recommend a treatment and send it to a pediatric urologist.

2-At what age do testicles descend?

The testicles should have completely descended at 6 months of age.

3-The doctor said that I need to monitor the position of the testicles, but I cannot find them in the bags. What should I do?

Try to examine your child in a relaxed state during a warm bath or after sleep. If you still cannot feel the testicles, let your doctor know.

4-Can we avoid surgery if our child has an undescended testicle diagnosed by a doctor?

Express your concerns with the pediatrician or pediatric urologist. Your doctor will help you decide whether surgery is needed. The pediatric urologist will tell you what the right treatment is and, if necessary, recommend the type and type of operation.

5-Our child is 12 years old, in his last examination, the pediatrician said that he felt the testicles in his abdomen, but that it descended into the scrotum from time to time. Is the testis damaged?

Generally, conditions inside the abdomen are not good for the testicles and they may lose their function. The testis can naturally move back and forth between the scrotum and abdomen and (retractile) no operation is needed. Your knowledge of the relaxed testicular position of your son’s testicles can play an important role in deciding on further treatment (operation).

6- Our son had surgery to lower the testicles into the scrotum (instead of normal). Does the operation have an effect on infertility? Can they have children when they grow up?

Men who do orchiopexy before 18 months of age are almost at the same rate as fathers with other children. Men with bilateral undescended testicles are at greater risk for infertility, so sperm testing can be done after puberty to check for fertility potential.

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