An undescended testes condition also known as “cryptorchidism” or “empty scrotum” is the most common genital pathology encountered in paediatrics. An undescended testis (UDT) is normally a congenital condition in which one (unilateral) or both of a baby's testicles (bilateral) have not moved into the scrotal sac. About 1-2 percent of male infants are affected worldwide. In about 20 percent of affected boys, an undescended testis will descend on its own within the child’s first six months of life. The outlook for children with a UDT is very good and your child just requires prompt treatment and plenty of reassurance.
Before a baby boy is born, the testes in a male foetus are formed inside the abdomen. The Trans-abdominal descent of the testes involves the differential growth of vertebrae and the pelvis as the testes move down the groin through the inguinal canal and into the scrotum during the third trimester, usually happens in the ninth month of pregnancy. This descent is facilitated by the growth of a foetal ligament the gubernaculum - which connects the testis to the bottom of the scrotum. A normal hypothalamic-pituitary-gonadal (HPG) axis is an important requirement for testicular descent.
A baby with UDT will have one or both of their testes located in the path of the descent in the groin or abdomen instead of the scrotum.
Congenital undescended testes
In babies born early, the testes may not have had time to move down into the scrotum by the time the baby is born.
The conversion of testosterone to dihydrotestosterone (DHT) is essential for the continued migration of testes and Intra-abdominal pressure also plays a role in testicular descent. The conditions associated with decreased pressure, such as cloacal exstrophy a birth defect where abdominal organs are exposed, Prune belly syndrome and gastroschisis where the abdominal contents protrude through the separation in the abdominal wall, are associated with an increased risk of undescended testes.
Babies born with Klinefelter’s syndrome, spina bifida or Down syndrome are more likely to have undescended testes.
Retractile testes (hypermobile testes) - the muscle attached to the testes (cremasteric muscle) pulls the testes up and that causes them to move back into inguinal canal from the scrotum to the groin. If the testes can be moved back down to the scrotal sac and stay there, then no further treatment is required. However, this condition need to be observed over a period of time.
Undescended testes can cause a range of health problems later in life:
Infertility: This is the most common complication of UDT when both testes don’t descend. Fixing the problem between six and 12 months of age can improve fertility later in life.
The Risk for testicular cancer: This risk of testicular cancer increases greatly by age 30 - 40. The risk is up to ten times greater than in the general male population.
Inguinal hernia: Undescended testes can widen and weaken the inguinal canal allowing the development of inguinal hernia.
Testicular torsion: This is a painful twisting of the testes on its spermatic cord that can cut off blood supply to the testes. The testicle may become damaged beyond repair without prompt medical attention and have to be removed.
Emotional stress: UDT increases poor self-image and psychological vulnerability.
There are two options for treatment of undescended testes:
Hormone injections: Hormones that stimulate testosterone production is used to make the child’s testicle to descend. According to recent research studies, this treatment method has only about a 10 percent success rate. It’s not as effective as surgery as the testicles may reascend, i.e., move back out of the scrotum.
Hormone injections work best if the testes are already very close to the scrotum. Some testicles may descend only part of the way or temporarily, when a child is treated with hormones. But this may still be beneficial, because the testes may descend to a position that is easier to treat with surgery.
Surgical treatment: If his testicle hasn’t descended before age 1year then testes may need to be surgically brought down in to the scrotum. This surgery is called Orchidopexy. The surgery is usually done as a short stay procedure and recovery typically takes about one week. The surgeon will make a small incision in his groin to allow his testicle to descend to a proper position. The spermatic cord that connects testis to the scrotum is released and lengthened and gently brought to the bottom of the scrotum and fixed with out any tension to the chord. Successful surgical placement of the testes in the scrotum requires sufficient mobilisation of the testes and spermatic vessels, fixation of the testes in a dependent portion of the scrotum and ligation of the associated hernia sac.
Dr. Mahendra Jain, Bangalore is one of the best urology specialists in India, having practiced the medical specialization for so many years. Dr. Jain performs around 700 surgeries a year. He is specialized in Endourology, Uro-oncology, Reconstructive urology, LASER Surgery for prostate, renal transplant, undescended testis orchiopexy Bangalore, Flexible uretereoscopy with Laser for RIRS and Penile prosthesis for impotency.
Visit@ www.best-urologist-doctor.com
Mail us: mahijain@yahoo.com
Book appointment: www.best-urologist-doctor.com/online-appointment.html
What causes undescended testes?
Before a baby boy is born, the testes in a male foetus are formed inside the abdomen. The Trans-abdominal descent of the testes involves the differential growth of vertebrae and the pelvis as the testes move down the groin through the inguinal canal and into the scrotum during the third trimester, usually happens in the ninth month of pregnancy. This descent is facilitated by the growth of a foetal ligament the gubernaculum - which connects the testis to the bottom of the scrotum. A normal hypothalamic-pituitary-gonadal (HPG) axis is an important requirement for testicular descent.
A baby with UDT will have one or both of their testes located in the path of the descent in the groin or abdomen instead of the scrotum.
The two types of UDT:
Congenital undescended testes
In babies born early, the testes may not have had time to move down into the scrotum by the time the baby is born.
The conversion of testosterone to dihydrotestosterone (DHT) is essential for the continued migration of testes and Intra-abdominal pressure also plays a role in testicular descent. The conditions associated with decreased pressure, such as cloacal exstrophy a birth defect where abdominal organs are exposed, Prune belly syndrome and gastroschisis where the abdominal contents protrude through the separation in the abdominal wall, are associated with an increased risk of undescended testes.
Babies born with Klinefelter’s syndrome, spina bifida or Down syndrome are more likely to have undescended testes.
Retractile testes (hypermobile testes) - the muscle attached to the testes (cremasteric muscle) pulls the testes up and that causes them to move back into inguinal canal from the scrotum to the groin. If the testes can be moved back down to the scrotal sac and stay there, then no further treatment is required. However, this condition need to be observed over a period of time.
What are possible complications of UDT in children?
Undescended testes can cause a range of health problems later in life:
Infertility: This is the most common complication of UDT when both testes don’t descend. Fixing the problem between six and 12 months of age can improve fertility later in life.
The Risk for testicular cancer: This risk of testicular cancer increases greatly by age 30 - 40. The risk is up to ten times greater than in the general male population.
Inguinal hernia: Undescended testes can widen and weaken the inguinal canal allowing the development of inguinal hernia.
Testicular torsion: This is a painful twisting of the testes on its spermatic cord that can cut off blood supply to the testes. The testicle may become damaged beyond repair without prompt medical attention and have to be removed.
Emotional stress: UDT increases poor self-image and psychological vulnerability.
Treatment:
There are two options for treatment of undescended testes:
Hormone injections: Hormones that stimulate testosterone production is used to make the child’s testicle to descend. According to recent research studies, this treatment method has only about a 10 percent success rate. It’s not as effective as surgery as the testicles may reascend, i.e., move back out of the scrotum.
Hormone injections work best if the testes are already very close to the scrotum. Some testicles may descend only part of the way or temporarily, when a child is treated with hormones. But this may still be beneficial, because the testes may descend to a position that is easier to treat with surgery.
Surgical treatment: If his testicle hasn’t descended before age 1year then testes may need to be surgically brought down in to the scrotum. This surgery is called Orchidopexy. The surgery is usually done as a short stay procedure and recovery typically takes about one week. The surgeon will make a small incision in his groin to allow his testicle to descend to a proper position. The spermatic cord that connects testis to the scrotum is released and lengthened and gently brought to the bottom of the scrotum and fixed with out any tension to the chord. Successful surgical placement of the testes in the scrotum requires sufficient mobilisation of the testes and spermatic vessels, fixation of the testes in a dependent portion of the scrotum and ligation of the associated hernia sac.
Dr. Mahendra Jain, Bangalore is one of the best urology specialists in India, having practiced the medical specialization for so many years. Dr. Jain performs around 700 surgeries a year. He is specialized in Endourology, Uro-oncology, Reconstructive urology, LASER Surgery for prostate, renal transplant, undescended testis orchiopexy Bangalore, Flexible uretereoscopy with Laser for RIRS and Penile prosthesis for impotency.
Visit@ www.best-urologist-doctor.com
Mail us: mahijain@yahoo.com
Book appointment: www.best-urologist-doctor.com/online-appointment.html
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