UNDESCENDED TESTICLES

Is your baby boy at risk?

One of the examinations that a doctor performs upon the birth of a baby boy, is a thorough review of the baby’s genitals. This is done to confirm that both testicles, or testes, are in their normal position in the scrotum. It is not unusual for babies, particularly premature babies, to be born with undescended testicles. One or both testicles may remain undescended. Under normal circumstances many cases self-correct. There are cases however, where medical intervention is necessary.

What happens in a normal situation?

Testicles develop early in a male foetus. When being formed, they are located in the abdominal cavity. Up to around 28 weeks when the foetus is developing in the uterus, the testes undergo intra-abdominal descent. When the foetus is between 28 and 32 weeks, the testes descend into the inguinal canal where they gradually move into the scrotum (the bag that contains testicles in a man). Testicles in the infant primarily make hormones. After puberty, testes produce both hormones and sperm.

Diagnosing undescended testicles

Testicles that fail to reach their normal position in the scrotum, are said to be undescended. This condition is obvious with routine examination in the infant, and is present in about 3 percent of newborn babies and up to 21 percent in premature newborns. Fortunately, most cases of undescended testicles will descend spontaneously during the first three months of an infant’s life. However, slightly less than I percent of infants with this condition will need treatment.

An expert physical examination will distinguish between descended and undescended testicles. Only undescended testicles need treatment.

A testicle that cannot be felt on clinical examination is said to be ’non-palpable’. Non-palpable testicles may be located in the abdomen or they may be atrophic— that is very small—or absent altogether. It is important to determine which of these is the case, because if the testicle is left inside the abdomen it could form a tumour later in life.

Normal babies aged six months and above have a reflex that pulls the testicles up to protect them from the cold: the same reflex also pulls them up when the child is frightened. Testicles go back into the scrotum once the threat of cold or fright is over. This is a natural process that does not require any treatment.

In adults, testicles function better in sperm production at temperatures slightly lower than the body’s temperature. This explains their natural location in the scrotum, which is cooler than other parts of the body. This is especially true for the part of the testicle that makes sperm.

Causes of undescended testicles

It is not known why testicles fail to descend but certain conditions are believed to contribute to the occurrence. These include abnormalities in the testes themselves, physical obstruction within the internal organs, insufficiency of maternal hormones that stimulate descent, prematurity which means the baby is born before full descent is achieved, an undeveloped scrotum, an undeveloped inguinal canal and abnormalities in the inguinal canal.

In infants testicles may fail to descend because they are not normal in the first place. Sometimes a mechanical problem leads them in the wrong direction (ectopic testicles) or the infant’s hormones may be insufficient to stimulate the testicles normally. Fortunately, there is no evidence suggesting that the problem is caused by anything the mother did or ate during pregnancy.

Many times when testicles fail to descend normally, an inguinal hernia may be present. The inguinal canal is a channel in the abdominal wall through which the sperm-carrying cord and vessels link to the testicles. A hernia is an abnormal protrusion of tissue or an organ through a defect in the wall of the abdomen.

When a tissue or section of an internal organ, for instance undescended testes, protrudes through the abdominal wall into the pelvic area it is referred to as an inguinal hernia.

An inguinal hernia is noticeable when your child is upright or when he is straining, coughing, crying or laughing. The condition indicates that the testes have lodged in the protrusion in the abdominal wall, and appear as a lump in the groin (area between the abdomen and the thigh).

Why you should worry

Testicles that do not descend into the scrotum are not likely to produce sperm. This is because sperm develop normally only if they are located in the scrotum. Thus undescended testicles are a cause of infertility especially when both testicles are affected. Undescended testicles are also associated with a higher risk of testicular cancer in adulthood.

Treatment

Treatment should be given any time after the baby attains six months. The best time is between six and eighteen months when taking into account surgical, anaesthetic and psychological factors. These three factors are important to ensure the baby’s organs have matured enough to withstand medical or surgical intervention as may be appropriate.

Two treatment options are available—hormonal and surgical. Hormone injections are given weekly or biweekly usually over four weeks, in variable doses based on the infant’s weight. It is safe and very successful in cases of retractile testicles (those that can be retracted or drawn back into the scrotum).

Another option is surgical treatment, referred to as orchidopexy. Orchidopexy requires general anaesthesia but the baby may go home the same day and usually acts entirely normal within one to two days. An incision about an inch long is made in the groin (it can hardly be seen later). The testicle is separated from all surrounding tissue and if there is an inguinal hernia it is removed at the same time so that the affected testicle descends easily into the scrotum where it is stitched in place.

In some instances the testicles may be too high for this simple operation and more complex procedures are needed.

What can be expected after treatment?

After treatment, the testicles usually develop normally in the scrotum. However, in some cases the testicles are abnormal to start with and never develop properly. In other cases, though testicles develop to normal size, sperm never develop. Fortunately, most children born with undescended testicles proceed to father children during adulthood.

END: BL 05/58-59

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