References: Undescended Testicles(Chinese Version)
Undescended Testicles http://www.nlm.nih.gov/medlineplus/ency/article/000973.htm
Alternative names
Cryptorchidism; Empty scrotum - undescended testes; Scrotum - empty (undescended testes); Monorchism; Vanished testes - undescended
Definition
The testicles develop before birth in the abdominal cavity. Normally, they descend into the scrotum before birth. Undescended testicle occurs when one or both testicles fail to move into the scrotum prior to birth.
Causes, incidence, and risk factors
Undescended testicles are fairly common in premature infants, and occur in about 3 to 4% of full-term infants. About 65% of the testicles typically descend by 9 months of age.
Once a testicle has been discovered in the scrotum, it is generally considered descended, even if it is temporarily retracted on a later examination. Sometimes a condition (referred to as retractile testes) will develop, in which the examiner can sometimes locate the testicles and sometimes not.
This occurs because of the strength of the muscular reflex (cremasteric reflex) that retracts the testicles and the small mass of the testicles before puberty. In this instance, the testicles descend at puberty. This is considered a variant of normal and surgical correction is not needed.
Testicles that do not descend by one year of age should be carefully evaluated. The literature suggest that definitive surgery should be accomplished by this age to confirm diagnosis and to lessen the likelihood of permanent testicular damage.
Testicles that do not naturally descend into the scrotum are considered abnormal throughout the patient's life. These undescended testicles have an increased likelihood of developing cancer regardless of whether or not they are brought down into the scrotum.
Bringing the testicle into the scrotum maximizes sperm production and increases the odds of good fertility. It also allows examination for early detection of testicular cancer.
In other cases, such as vanished testis, no testicle may be found upon surgical exploration. This may be due to in utero vascular insult (testicular torsion), resulting in an infarction (death of affected tissue).
Alternatively, this may be associated with congenital anomaly, in which case blind-ending blood vessels are seen in the vas deferens (the tube which normally carries sperm).
Symptoms
There are usually no symptoms other than inability to find the testicle within the scrotum (may be described as an empty scrotum). Adult males with an undescended testicle may complain of infertility.
Signs and tests
Examination confirms that one or both of the testicles are not present in the scrotum.
The undescended testicle may or may not be felt in the abdominal wall above the scrotum.
Treatment
Usually the testicle will descend into the scrotum without any intervention during the first year of life. If this does not occur, hormonal injections (B-HCG or testosterone) may be given in an attempt to stimulate movement of the testicle into the scrotum.
Surgery (orchiopexy) is the definitive therapy. The trend in literature favors earlier surgery to prevent irreversible damage to the testis, which may cause infertility.
Expectations (prognosis)
The majority of cases resolve spontaneously, without any treatment. Medical or surgical correction of the condition is usually successful.
About 5% of patients with undescended testicles do not have testicles that can be found at the time of surgery. This is called a vanished or absent testis.
Complications
If one or both testicles do not descend, a man may be infertile later in life. Men who have an undescended testicle at birth are at higher risk of developing testicular cancer in both testes.
Calling your health care provider
Call your child's health care provider if he appears to have an undescended testicle.
Call your provider if you are a male, 15 years or older and you are unsure how to perform testicular self-examination (TSE) to screen for testicular cancer.
Undescended Testicles http://www.pedsurology.com/undescen.htm
Introduction
What Is Undescended Testis(Cryptorchidism)?
The testicles develop in the abdomen and usually descend into the scrotal sacs by the time of birth. Crytorchidism (Undescended testes) is one of the most common malformations in young boys and occur in about 4 out of every 100(4%) of newborn boys. Fortunately, most (75%) of these undescended testicles will eventually descend into the scrotal sacs on their by the first birthday. After the first birthday, however, it is very unlikely for a testicle to descend.
An undescended testicle must be distinguished from a retractile testis, one which is normal but has temporarily pulled up out of scrotal sac into the groin area. Upon examination the testicle can be pulled into the scrotal sac.
Your child has been examined and found to have a "cryptorchidism," or undescended testicle(s). Since the testicles cannot be felt or manipulated down into the scrotum, surgical treatment is recommended.
An undescended testicle should be brought down into the scrotum as early as possible, preferably before the child is one year old. This is thought to preserve the function of the testicle with regard to fertility. A testicle that has not fully descended into the scrotum by age 6 months will not do so thereafter. Hormonal manipulation has been found to be ineffective in true undescended testes. Retractile testes are more likely to respond to hormonal treatment. Occasionally, we will use hormonal therapy to differentiate retractile testes from undescended testes.
What Problems Can Undescended Testis Cause?
An undescended testis that remains outside the scrotum throughout childhood may result in impaired or abnormal testicular development which could result in future infertility.
Another concern is an increased risk of tumor development in the undescended testis during early adulthood. Fortunately, the occurrence is uncommon. Careful periodic examination of the testicles by a physician and self-examination is therefore desirable throughout life.
In addition, most undescended testicles are associated with a congenital (present at birth) hernia and are more prone to injuries than a testicle located within the scrotal sac.
What Is The Treatment For An Undescended Testis?
Operative treatment (surgery) is performed to bring the testicle down into the scrotal sac and to prevent or lesson the likelihood of problems associated with an undescended testicle. In addition, the congenital hernia is corrected at the same time the undescended testicle is placed within the scrotal sac.
Non-operative treatment might include a series of hormone shots to stimulate testicular growth and descent into the scrotal sac. Unfortunately, results of hormone therapy have not been predictable and are generally unsuccessful.
When Should The Surgery Be Done?
Surgery at the age of 1 year is now recommended and should allow for maximum preservation of fertility. This may reduce the risk of developing testicular tumors later in life. Furthermore, surgery at this age allows for a normal male appearance before the school age.
The Surgery
The goal of surgery is to bring the testicle(s) into the scrotum; the procedure is usually done on an outpatient basis. This means your child may come into the hospital in the morning, have the operation under anesthesia, and go home the same afternoon. He may be required to stay overnight if he has other medical problems, such as asthma or diabetes, or if both sides need to be repaired.
The surgery consists of making a small incision in the groin to locate the testicle. Once located, the testicle is brought down into the scrotum through a small scrotal incision. It is then sutured (stitched) into the scrotum. In some instances the testes are in the abdominal cavity. Laproscopy, looking into the abdomen with a telescope is necessary. In cases where the testes is intraabdominal the testes can be brought down using a Laproscopic technique, which minimizes the size of the incision and discomfort post operatively.
The groin and scrotal incisions are closed with sutures that dissolve and do not have to be removed. Following surgery, the scrotum usually becomes "black and blue" and swollen. This will take several weeks to disappear. If your child experiences pain at home, Tylenol or Tylenol with codeine can be given.
Preparing Your Child for Surgery
If your child is toddler age, you may explain that he will go to the hospital for one day to have an operation. Since he is just beginning to talk, and his understanding of surgery is limited, simply tell him that the doctor is going to fix his testicle ( use whatever name with which he is familiar).
Your child will need reassurance that you will be there. He may be frightened by the unfamiliar hospital routines and environment but will be comforted if you reassure him that you are not going to leave him and that he will return home soon.
Your child may wish to bring a special toy, doll, or blanket with him when he comes to the hospital. Of course, your presence is his best source of comfort. You will be able to stay with him as long as possible both before and after surgery.
Remember: Do not give your child aspirin or Ibuprofen. Your child may be reluctant to walk at first, but encourage him to walk the day after surgery. He may return to school in two or three days and may participate in sports after his postoperative check-up.
We hope this has answered some of your questions. If you have any additional questions, please contact us for further assistance.
Five Easy Steps
to Early Detection of
Testicular Cancer
1. Cancer of the testes is one of the most common cancers in men 15 to 34 years of age.
2. The most common type of testicular cancer-seminoma-has a survival rate approaching 100 percent in cases detected and treated early.
3. Men who have an undescended or partially descended testicle are at a higher risk of developing testicular cancer than others.
4. If discovered in the early stages testicular cancer can be treated promptly and effectively.
5. Your best hope for early detection of testicular cancer is a simple three minute self-examination. Pubescent boys should be instructed regarding self-examination of their testes even when their undescended testes has been brought down successfully in childhood. Roll each testicle gently between the thumb and fingers of both hands. If you find any hard lumps or nodules or notice any sudden enlargement of your testicles you should see your doctor promptly. They may not be malignant, but only your doctor can make the diagnosis.