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Undescended Testis in children

Dr. Prathibha Sukumar,Consultant Paediatric Surgeon,SUT Hospital, Pattom
What is undescended testis?

When either one or both testes are not found in the scrotum, it is said to be undescended. Rarely the testes may have become shrunken or atrophied.

Why does it occur?

As a part of development of the embryo, the testes are formed inside the abdominal cavity close to the kidneys. For the proper development of sperm cells, a cooler temperature is required, so the testes move downwards and outside the abdominal cavity into the scrotum. By the last month of pregnancy, the testes move through a passage in the muscular wall of the abdomen and into the scrotum. Due to problems in this mechanism, the testis on one side or both may fail to descend into the scrotum leading to undescended testes.

How to detect undescended testis?

On examining a newborn baby, one or both testes may not be felt in the scrotum. The scrotum on one side appears smaller than the other. The testis may be felt in the muscular wall- said to be the palpable testes. Sometimes the testis may not be felt- said to be non palpable testis.

What tests need to be done?

Ultrasound scan of this region can detect a testis located in the muscular wall. Sometimes a testis located in the abdomen can also be identified. MRI scan may also help to locate the non palpable testis. However both these scanning methods are not very accurate. If the condition affects both testes, further hormonal tests and other tests may be needed to identify any other conditions like sexual developmental disorders.

How to treat this undescended testis?

On examining the child, if it is a palpable testis- open orchidopexy surgery is done. By an incision on lower abdomen the testis is located and brought down and fixed in the scrotum through another smaller scrotal incision. If the testis is not palpable or felt, Laparoscopic surgery is done. The testis can be localized and brought down. Sometimes if the length of the spermatic cord or blood vessels is insufficient a two stage procedure may need to be done.

When should the surgery be done?

The cells in the testis have been found to get damaged by 9-12 months age. Hence the undescended testis should be surgically corrected by 4-6 months age.

Why should it be surgically corrected?

If the testis remains inside the abdomen, sperm cells can get damaged affecting the male’s future fertility. Also these testes have higher chance of developing cancerous changes. So by placing them in the accessible scrotum, early detection of tumor can be done. These children need to be taught about self examination from adolescence. Testes remaining in the lower abdominal wall can get injured easily. Also a twisting of the blood vessels can occur- so called torsion testis which is a surgical emergency. The intestines can also bulge out through this muscular canal (hernia). This can get complicated leading to a need for emergency surgical correction. Hence, due to all these reasons an early surgical correction of an undescended testis is necessary.