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Undescended testicle

Overview

Undescended testicle is a condition in which one or both testes fail to move into the scrotum before birth. The scrotum is a sac behind the penis which holds both testes. The medical name for this condition is known as cryptorchidism. In the majority of the cases, only one testicle fails to descend to its normal position. This is more often seen among boys who are born prematurely. However, this condition does not last for a long time. After one to three months of birth, the affected testes descend to their normal position. If that does not happen within the first few months of birth, consult a medical expert for further help. 

Causes

The exact causative mechanism of an undescended testicle is unknown. During pregnancy, the testicles develop in the abdominal region. Once their development is complete, they descend into the scrotum through the inguinal canal around the 8th month of pregnancy. Premature birth may disrupt this natural process. The newborn baby may miss one or both testicles in his scrotum.

It is thought that this condition is multifactorial rather than being caused by a single reason. It can be a combination of certain factors, including genetic issues, hormonal imbalance, maternal health, physical or environmental influence, and issues related to nerves involved in the normal development of testicles. 

Risk Factors And Epidemiology

Some risk factors may increase the probability of an undescended testicle. One major reason is premature birth or low birth weight. This can be a sign of incomplete development. Due to this reason, an undescended testicle is the most common birth defect related to male genital organs. Family history of this condition or other conditions that retard normal development of the fetus (such as Down’s syndrome) also leads to a higher risk. Studies have also noticed that females who drink alcohol or smoke during pregnancy may have developmental defects in their babies, including undescended testicles.

As reported by American Urological Association (AUA), around 3% of full-term males and 21% of premature males are born with undescended testicles. Because the testicle descends into the scrotum within a few initial months of life, the cases of this condition are very rare among adults. 

Signs And Symptoms

The basic sign of an undescended testicle is when either one or both testicles are absent from the scrotum. In this case, the doctor will palpate around the genital region to look for the missing testicle. In the majority of the cases, an undescended testicle is palpable around the end of the inguinal canal. If the testicle is not palpable, it is either present in the early part of the inguinal canal or the abdominal cavity or has never fully developed. No other systemic signs or symptoms, such as pain, discomfort, etc., are present. 

Diagnosis

During the stage of infancy, a physical examination is performed to palpate the undescended testicle and identify its location. If the testicle is not palpable, an MRI with contrast may be done to visualize the location and position of the undescended testicle. The doctor may need to perform a laparoscopic surgery that can aid both diagnosis and treatment in specific cases. Open surgery is only indicated for rare and complex cases of undescended testicles. If both of the testicles are undescended or absent, genetic testing is done to identify the sex chromosomes of the baby.  

Treatment

If your child’s testicle does not descend into the scrotum within the first 4 months of life, a surgical procedure will be required to bring it to its normal position. This surgery is known as orchiopexy. This is done when the child is in an age range of 6 to 18 months. Getting the surgery done within the first year is suggested because delaying it can increase the risk of infertility and testicular cancer.

During this surgery, the doctor pushes the undescended testicle into the scrotum and stitches the end of the inguinal canal to limit the retraction of the testicle. This can be done via laparoscopy or open surgery. Usually, the child recovers and is sent home within a day. Follow-up is required if a complication occurs after surgery. 

Prognosis

The prognosis of orchiopexy is 100%. It is one of the most reliable and successful methods to treat undescended testicles without severe complications. The child may develop infertility, testicular torsion, or testicular cancer if left untreated. However, the risk of these complications is very rare. 

Prevention

Because its causative mechanism is unknown, there are no ways to prevent this condition. It can develop in any child. The least preventive measures that could be done include avoiding alcohol and smoking during pregnancy, maintaining proper health, and getting regular checkups to notice abnormalities during fetal development.