Undescended TesticleWhat is an undescended testicle?Undescended testis or "cryptorchisism" is one of the most common surgical disorders in childhood. Referred to at times, as "empty scrotum" this disorder occurs in 0.8% to 1.1% in male children. What causes undescended testes?During the 7th to 8th month of gestation (the location before birth) the testis descend into the scrotum during fetal development. The testes are located on each side of the fetal spine and are drawn downward through the back of the abdomen and pass through the abdominal wall and groin to take its normal position into the scrotum. In some children, particularly those that are born prematurely, this will not occur. In this case, the testicle may be located in a site either high up in the inguinal canal (groin) or in the abdomen. When a testicle is not in the normal scrotal location several possibilities exist:
Why should an undescended testicle be treated?In humans, the scrotal location of the testicles keeps them cooler than the core body temperature. This lower temperature is important for the development of the testicle as well as for production of normal sperm. Studies have shown that there is an increased risk of infertility in men with a history of undescended testicles. Relocating the testicle into the scrotum may decrease the risk of fertility problems, particularly if done at an early age. There are other advantages to a location within the scrotum. There is a cosmetic advantage. The scrotal testicle may be less amenable to injury than a testicle outside the scrotum. Finally, and perhaps as important as any other reason, a testicle that has not made it into the scrotum is not accessible to physical examination. Undescended testicles are at increased risk for cancer. Testicular cancer may not occur until after age 40 years. Testicular carcinoma is highly curable, when detected early, and the best way to do this is monthly self-examination, which can only be done if the testicles are within the scrotum. The major indications for treatment by orchiopexy include:
Orchidopexy: How is the surgery done?Surgery for undescended testicle is performed in an outpatient setting. Your child will have general anesthesia. When a testis is felt in the groin area we usually explore the area through a small incision first. Surgical correction is done by dissecting the spermatic artery and veins and the vas deferens to have adequate length to move the testicle to the correct spot into the scrotum. Most undescended testes are associated with a hernia that must be repaired.(please refer to the hernia handout for more information on this procedure) After this is done, the testis is brought down into the scrotum (secured as low as possible) and anchored in a space created in the scrotum (orchiopexy). This procedure is done with two surgical incisions one in the groin, and one into the scrotum. See diagram of surgery below:
What to expect after the surgeryYour child will receive a complete set of instructions on wound care after the surgery. He will be uncomfortable for a few days after surgery, and will generally miss 2 to 4 days of school. He most likely should not participate in physical education or sports for at least 2 weeks after surgery. He will be given pain medication for discomfort, and will notice discomfort if he is too active. He will have sutures on his scrotum where the testicle has been brought down. These sutures should have a triple antibiotic ointment placed over the area at least 3 times a day. In general, these sutures will fall out, without the need for suture removal, in the first 7 to 10 days after surgery. Why is it important to continue to follow up with a physician even after the testicle is placed in a correct position?Even though the testicle is placed in an anatomically correct position, your child is at risk for two major problems. The first is an increased risk of testicular cancer. This risk involves both testicles even if only one was found to be involved. In general, most children will never develop a cancer, however, the risk is greater than the general population and your child will need follow up. Such cancers usually do not occur before the teenage years, but the risk continues throughout adulthood. Because of this, your child will need to see a physician on a yearly basis for a testicular exam. Additionally, as your child gets older, they should be taught how to perform a monthly testicular examination. This is the best way to detect any abnormal lumps or bumps in the testicle, and get medical treatment as soon as possible. The second risk is that your child will have a decreased ability to father a child compared to the general population. Although he still has testicles, and he will go through puberty, the testicles may not function as well as normally descended ones. Although he still has a good chance of be able to father, this will be a subject which you will need to make sure he becomes aware of as he enters adulthood. When should I call to speak with a nurse?If your child has:
If you have questions or concerns contact us at:
This information is provided by the University of Michigan Department of Surgery, Section of Pediatric Surgery and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. For additional health information, please contact your health care provider or our offices. |
