What is an undescended testis?
Testes develop in the abdomen near the kidneys and move down into the scrotum during the last 2 months of pregnancy. If for some reason the testis does not reach the scrotum it is referred to as an ‘undescended’ testis.
How common are undescended testes?
About 1 in 100 boys need an operation to correct an undescended testis. In about 1 in 10 of these, both testes are affected.
Where are undescended testes?
Most can be felt in the groin region (also known as the ‘inguinal’ region).
About 1 in 10 undescended testes cannot be felt at all and are either inside the abdomen, in the tunnel that goes from the abdomen to the groin (called the ‘inguinal canal’) or is not present at all.
What problems can occur with an undescended testis?
Testes require an environment a few degrees cooler than the rest of the body in order to develop normally. If undescended, the environment is too warm and subsequently development is not normal.
Atrophy
If left in the undescended position long enough the testis will fail to grow (called ‘atrophy’)
Infertility
The sperm cells in the affected testis will not develop normally. If surgery is performed early in life to correct the undescended testis fertility should be almost normal. If both testes are affected the chances of fertility are less.
Testicular cancer
There is a moderately increased risk of cancer of the testis occurring in grown men who had an undescended testes as a child. This risk is approximately 1 in 100. The cancers have a good cure rate if detected early and treated appropriately. They tend to occur in men in their 20′s and 30′s.
Boys who have had undescended testes should perform testicular self examination from teenage years on. If a lump or any other abnormality is detected he should see a doctor immediately.
How are undescended testes treated?
Undescended testes at birth can be observed for a few months because many will come down. After 3 months, however, all that will come down have done and surgical management is indicated.
The treatment is surgical – an operation.
How is the operation performed?
Under a general anaesthetic (fully asleep).
If the testis can be felt, an incision is made in the inguinal region. The testis is freed up so that it can reach the scrotum. Another incision is made in the scrotum and the testis is put in a pouch in the scrotum. This operation is called an ‘orchidopexy‘.
If the testis cannot be felt, a laparoscope (like a telescope) is placed in the umbilicus (navel) to look inside the abdomen in case the testis is there. If it is, it may be able to be brought down into the scrotum at that time (‘laparoscopic orchidopexy’) or it may need a staged procedure (a second operation done a few months later). If the testis is not in the abdomen an incision is made in the inguinal region and it is looked for there.
If the testis has shriveled up and disappeared, it is recommended that the remaining testis is fixed with fine stitches to avoid any possibility of it twisting and dying in the future.
What are some of the possible complications?
- Infection
- Bleeding
- Recurrent undescended testis, requiring another operation
- Testicular atrophy, where the testis shrinks or does not grow
These are uncommon.
What to expect after the operation
Stitches:
The stitches are dissolvable and usually cannot be seen because they run under the skin (‘subcuticular’). Some stitches in the scrotum may be visible but they will dissolve and fall out by themselves.
Pain:
Your surgeon or anaesthetist will usually use local anaesthetic to reduce pain after the operation. This wears off after a few hours. At home, give paracetamol for pain relief.
