What is undescended testis?
Undescended testis - also known as cryptorchidism - is a condition which causes one or both testicles not to be present in the normal position inside the scrotum. It is estimated that 1 in 25 newborns has undescended testis at birth. Some of these babies will be normal as the testis can still migrate down to the scrotum up to the age of three months. In general, only one testicle is affected (undescended testicle), although in around 10 percent of cases both testicles are undescended.
For cases in which an undescended testicle has not corrected itself, surgery can relocate the testicle to the scrotum.
What is an undescended testicle and is it common in children?
Undescended testes is a condition in which one or both of the testicles do not descend into the scrotum at birth, but remain in the abdomen. Mr Stefano Giuliani is a top paediatric surgeon who treats problems in infants and children, including corrective surgery for undescended testes. Make an appointment with Mr Giuliani here:
What causes undescended testis?
The cause of undescended testis is not completely known. For some reason there is a mistake in the process which is moving the testis from the tummy, where the testis is developed, to the scrotum. This migration should occur in the last two months of foetal life but it can also happen in the first three months of postnatal life as mentioned above.
It is thought that there may be several factors - such as genetics, environmental factors, and maternal health - which could disrupt hormones and nerve activity, impacting on the development and migration of the testicles.
Risk factors associated with an undescended testicle in newborn boys include: premature birth; a low birth weight; foetal conditions which can restrict growth, like a defect in the abdominal wall or Down Syndrome; use of cigarette smoking or alcohol during pregnancy.
How to recognise an undescended testis?
The main presentation of undescended testis is with an empty scrotum and an absent palpable testis.
In general, the undescended testis is detected soon after birth. Your son would typically be examined regularly, and if the testicle has not moved down into the scrotum by three months, it is likely that the problem will not correct spontaneously, and a surgery will be required.
It is important that undescended testis are treated while your son is a baby in order to increase the chances of fertility. Other important reasons to correct an undescended testis are the easier detection of testicular lumps and bumps (ie cancer) and normal appearance of the scrotum.
Treatment options for undescended testis
The surgery to correct undescended testis is called orchidopexy. It requires one small incision in the groin and a second one in the scrotum. This operation is usually performed as a day case, and your child will be back to his normal in a couple of days.
Key-hole surgery (laparoscopy), which uses a tiny camera placed through the belly button, is needed when the testicle in non-palpable in the groin. It is possible, in this case, that the testicle is either inside the abdomen or it was never developed.
Surgery involves the careful manipulation of the testicle to separate some congenital adhesions that are keeping the testis away from the scrotum. Then a tunnel and a pouch are created to bring the testis in the final position inside the scrotum where the testis is stitched in place.
For cases in which the testicle is abnormal, or not developed, the recommendation is to remove the nibble or small residual testis to avoid problems, such as cancer, in the adult life.
An inguinal hernia or hydrocele may be associated with the undescended testis, and they can be repaired during the same operation.
Following the procedure, the testicle will be monitored for a few years to ensure that it is developing normally, and it remains in place.
"Mr Giuliani took fantastic care of our Son who had an operation for his testicle. From the first consulation to surgery and aftercare he was brilliant and very caring. He is professional, very calm and reassuring. We felt we were in the very best of hands. We would thoroughly recommend him."
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