Undescended Testicle

Description: 

What is an undescended tetsicle?
The undescended testicle is the most common birth abnormality involving the male genitalia. Any testicle that does not occupy a dependent scrotal position at birth is undescended.
 

Incidence of undescended testes

Age Incidence
Premature Infant 10%
Full-term Infant 3%
6 months .8%
Puberty .8%

These statistics demonstrate that most undescended testes will descend during the first few months of life and the diagnosis can be made with confidence by re-examination by age 6 months. A retractile testicle represents a “normally” descended testicle that is pulled out of the scrotum by an overactive cremasteric muscle reflex. This commonly occurs between ages 2 and 7 in boys and can be confused with a truly undescended testicle. Proper physician exam allows accurate diagnosis and further treatment is not required for retractile testes.
 

Problems associated with undescended testes

  • Infertility
  • Inguinal hernia
  • Testicular tumor
  • Psychological/cosmetic
  • Injury/torsion (twisting)

Where are undescended testes located?

  • High scrotal (gliding or prepubic)
  • Superficial inguinal region
  • Inguinal canal
  • Intra-abdominal
  • Ectopic (outside of normal descent)

Surgical Treatment
Surgery is performed through a short transverse inguinal skin incision. After the undescended testicle is found, the blood vessels to the testicle are lengthened by releasing fibrous and peritoneal attachments. The testicle can then be pushed down into the scrotum and stitched into the proper position. In the case of the nonpalpable testes (i.e., an intra-abdominal testicle) treatment may involve laparoscopy. This involves looking inside the abdomen first to define the presence of a testicle and then with the use of laparoscopy, proceeding with orchiopexy to place the testicle in the scrotum. When indicated, laparoscopic assisted orchiopexy avoids the need for an inguinal incision and is performed as an outpatient procedure.

Post-operative Instructions

  • Your child will usually be discharged from the hospital the same day of his surgery.
  • Discomfort (soreness) is common for a couple of days in the area of the groin or scrotal incisions. Tylenol is most helpful.
  • We recommend only sponge-bathing for 3 days following surgery, then regular baths or showers can resume.
  • Avoid strenuous activities such as wrestling, gymnastics, swimming, or ball playing for 1 week.
  • He may return to school in 2 days if he feels up to it.
  • If your child feels warm, please check his temperature. Should this be above 101⁰F, call our office for further advice.
  • Please call our office for an appointment 1 month after the surgery.

What are the treatment alternatives?
Hormonal therapy available in the United States requires anywhere from 3 to 9 intramuscular injections of human chorionic gonadotrophin (HCG) to stimulate testicular descent. Although acceptable based on parental preference, this is not recommended routinely because of the necessarily painful mode of administration and poor response noted in children (about 10% success). An alternate form of hormonal stimulation administered by nasal spray (LHRH) is at present considered experimental and is not approved for this use by the FDA.

We recommend surgical correction (orchiopexy) as the most effective treatment for this condition. The ideal timing for surgery is between ages 1 and 2 years, though there are often situations that are clearly identified at a later age and are corrected in older children. There is no benefit in allowing a child to grow until puberty hoping for descent of the testicle.