Undescended testicles

Undescended testicles is a condition in which one or both of a baby boy's testicles (testes) have not moved down into the bag of skin hanging below the penis before birth. It is also known as cryptorchidism. Testicles are oval-shaped male sex organs that produce sperm and testosterone hormone. After 6 months of age, Child's testicles drop into his scrotum from the abdomen. The scrotum is a small pouch of skin below the penis.

Undescended testicles may increase the risk of testicular cancer or hernia in adulthood. An undescended testicle is directly associated with sperm production in men. Undescended testicles problem is common in premature baby boys.

There could be many reasons for undescended testicles as:

• Baby's hormones are not stimulating the testicles normally
• Testicles are not developing normally
• Abnormal genital development or genetic disorder is not responding to male hormones
• Premature birth of baby
• Family history of genital problem
• Low birth weight, diabetes, or obesity
• Down syndrome that slow fetal growth
• Environmental factors, such as exposure to smoking, chemicals, or pesticides

Testicles are expected to be in the scrotum and if it is not present there is the clear sign of an undescended testicle. When an undescended testicle can be felt in the physical examination is called palpable. When an undescended testicle is left inside the abdomen, it cannot be felt. It is called nonpalpable. Nonpalpable testicles could form a tumor later in life. Treating an undescended testicle after birth lowers the risk of complications. Undescended testicles could be in:

• Abdomen
• Moved into the inguinal canal
• Atrophic or never formed
• Returned to the groin
• Moves back and forth between the scrotum and the groin due to a muscle reflex in the scrotum.

Most often doctors find the problems soon after the birth during their regular check-up. In some cases, the following diagnostic tests are recommended:

• An X-ray or ultrasound imaging test shows the location of an undescended testicle.
• An MRI scan with a contrast dye confirms the presence of testicles in the groin or abdomen or the absence of testicles.
• A Laparoscope through a small incision in the abdomen locates an intra-abdominal testicle.
• Direct exploration of the abdomen or groin through a larger incision is a rare and complicated case
• Blood and urine tests to measure hormone levels

Normally, the testicle descends on its own within 3 months. If it has not descended within 6 months, the surgery is recommended for a 6-12 months old baby.

• Orchidopexy procedure is recommended to be done before 2 years as delays may increase the risk of cancer and infertility. The surgeon will make a small incision in the abdomen and make it freed from all nearby tissues so the testicle moves down to an appropriate position. After the surgery, they stitch the inguinal canal to stop the testicle from moving back up.
• Sometimes they remove the abnormal tissue that is holding the testicles.
• In some cases, surgery is done to stretch the ligament that holds the testicle. This helps testicle descending easily into the scrotum.
• Laparoscopy surgery is done through a small tube that located the testicle and fixes it. It also removes non-functioning tissue that keeps the testicles from descending.

Treating an undescended testicle in early childhood lower the risk of complication in life.