Guidelines for Undescended Testis
Normally, the testes migrate from the abdomen to the scrotum sometime between the 7th fetal month and birth. With undescended testis means that the testicles have not descended into the scrotum. The reason why the testicles are not descended is partially obscured. We believe, however, that there are hormonal and mechanical factors involved in undescended testis. This can lead to malfunction and possibly infertility and an increased risk for malignancy. Treatment is primarily surgery and the optimal time for surgery is considered to be when the child is between 9-24 months. The surgery is often performed as an outpatient surgery which means that the patient can go home on the same day of operation. Surgical results are good and complications are rare.
Incidence :
Approximately 3-4% of full-term boys and 15-20 % in preterm boys.
Spontaneous descend may occur during the first 6 months of life but it is very rarely after 6 months of age.
Differential Diagnosis:
Undescended testis is sometimes difficult to distinguish from retractile testis. If the testicle can be pulled down into the scrotum and remains there after a while (about 30 seconds traction) is deemed to be retractile testicle. Clear retractile testes need to be followed after 3-6 months for another control.
Investigation:
If the surgeon is satisfied with the clinical examination then there is no need for further investigations.
In case of doubt or the testis is not palpable then ultrasound is indicated to localize the testis. Sometimes even the ultrasound cannot detect the presence of the testis and in this case laparoscopy is the method of choice to find the testis.
Operation Methods:
Surgery is usually done through the groin incision and a small pouch cut to place the testicle in a pocket in the scrotum and secured with a suture.
Laparoscopy is used for diagnostic and therapeutic purposes when the surgeon does not feel the testis on examination. Laparoscopy detects the position of the testis in the abdomen (if it exists) and the surgeon will try to bring the testis down in the same session or it may require a second operation after 6 months.
If the testis is absent then the other normal side needs to be fixed in the scrotum to avoid twisting problems in the future.
Follow-up
The wound of the operation needs to be checked after one week. The child should be examined about 6 months after the operation to check testicle size and position.
Recurrence of undescended testis is rare but it can happen if the testis is very high during the initial operation.
NB: For patients with ectopic testis, please refer to Dr.Naji’s study which was published in Pediatric Surgery International in 2012, http://www.ncbi.nlm.nih.gov/pubmed/22610649.
Author:
Dr. Hussein Naji
Consultant Pediatric Surgeon
Swedish Board Certified in Pediatric Surgery
European Board Certified in Pediatric Surgery
Normally, the testes migrate from the abdomen to the scrotum sometime between the 7th fetal month and birth. With undescended testis means that the testicles have not descended into the scrotum. The reason why the testicles are not descended is partially obscured. We believe, however, that there are hormonal and mechanical factors involved in undescended testis. This can lead to malfunction and possibly infertility and an increased risk for malignancy. Treatment is primarily surgery and the optimal time for surgery is considered to be when the child is between 9-24 months. The surgery is often performed as an outpatient surgery which means that the patient can go home on the same day of operation. Surgical results are good and complications are rare.
Incidence :
Approximately 3-4% of full-term boys and 15-20 % in preterm boys.
Spontaneous descend may occur during the first 6 months of life but it is very rarely after 6 months of age.
Differential Diagnosis:
Undescended testis is sometimes difficult to distinguish from retractile testis. If the testicle can be pulled down into the scrotum and remains there after a while (about 30 seconds traction) is deemed to be retractile testicle. Clear retractile testes need to be followed after 3-6 months for another control.
Investigation:
If the surgeon is satisfied with the clinical examination then there is no need for further investigations.
In case of doubt or the testis is not palpable then ultrasound is indicated to localize the testis. Sometimes even the ultrasound cannot detect the presence of the testis and in this case laparoscopy is the method of choice to find the testis.
Operation Methods:
Surgery is usually done through the groin incision and a small pouch cut to place the testicle in a pocket in the scrotum and secured with a suture.
Laparoscopy is used for diagnostic and therapeutic purposes when the surgeon does not feel the testis on examination. Laparoscopy detects the position of the testis in the abdomen (if it exists) and the surgeon will try to bring the testis down in the same session or it may require a second operation after 6 months.
If the testis is absent then the other normal side needs to be fixed in the scrotum to avoid twisting problems in the future.
Follow-up
The wound of the operation needs to be checked after one week. The child should be examined about 6 months after the operation to check testicle size and position.
Recurrence of undescended testis is rare but it can happen if the testis is very high during the initial operation.
NB: For patients with ectopic testis, please refer to Dr.Naji’s study which was published in Pediatric Surgery International in 2012, http://www.ncbi.nlm.nih.gov/pubmed/22610649.
Author:
Dr. Hussein Naji
Consultant Pediatric Surgeon
Swedish Board Certified in Pediatric Surgery
European Board Certified in Pediatric Surgery