What is an undescended testicle
The testicles are the male reproductive organ responsible for the production of sperm and the secretion of sex hormones.
The testicles are the male reproductive organ responsible for the production of sperm and the secretion of sex hormones. A condition in which the testicles cannot reach where they should be during the development process in the womb is called undescended testis (cryptorchidism). The testicles are located in the abdomen (abdomen) during the embryonic period in the womb. In the process of embryonic development, the testicles descend into the scrotum. The scrotum is the bag-like structure in which the testicles are located. An undescended testicle is a condition in which one or both testicles do not descend into the scrotum and remain in the abdomen or groin.
What are the Symptoms of Undescended Testicles?
The most important symptom of an undescended testicle is that on the problematic side the scrotum looks less developed, small. Although rare, in some cases the undescended testicle can become entangled (testicular torsion), causing severe groin pain. In this case, the nearest health center should be contacted immediately.
How to Recognize an Undescended Testicle?
An undescended testicle is understood by noticing the absence of a testicle in the patient's scrotum or by detecting that the testicle is not in place during a manual examination. During the neonatal period, an undescended testicle examination should definitely be performed during the examination of the genital tract. An undescended testicle can be one-sided, as well as a situation in which both testicles remain in the abdomen can be encountered.
Why Does an Undescended Testicle Occur?
The mechanism of formation of the undescended testicle has not yet been fully clarified. Many factors such as genetics, maternal health and environmental factors are thought to play a role in the development of this process. With the combination of one or more of these factors; some physical and hormonal changes occur that prevent the testicle from Decaying normally.
Some factors increase the likelihood of undescended testicles in babies. These:
* Low birth weight
* Premature birth
* Presence of an undescended testicle or other genital organ anomaly in the family
* Conditions that restrict the development of the fetus in the womb (such as Down syndrome)
* Mother's use of alcohol during pregnancy
* The mother smokes or is a passive smoker
* It can be listed as the exposure of parents to certain chemicals. The incidence of undescended testicles has increased in infants affected by these factors.
Retractile testis is a condition that occurs as a result of excessive activity of the muscle that holds the testicle in the scrotum. In the retractile testicle, the testicle is located where it should be. However, in some cases, as a result of excessive activity of the muscle, it recedes and goes into the abdomen. comes back when the muscle activity ends. In this case, treatment is not needed. In those with recessive testicles, this condition can progress to an undescended testicle over the years. In the case when it progresses to an undescended testicle, the need for treatment arises.
What Causes an Undescended Testicle?
In order for the testicles to develop and perform their functions, they must be located at temperatures slightly lower than body temperature. When they are at body temperature, they have problems performing these functions. That is why the fact that the testicles are in the scrotum protects them from body temperature. In the scrotum, the temperature is 1-2 degrees lower than in the body.
The undescended testicle is located in the abdomen or groin, not in the scrotum. That is why it is at body temperature. High temperature disrupts its functions, causing problems.
Infertility is one of the negative effects of undescended testicle. A decrease in sperm count and quality is observed. A condition in which one testicle is affected does not pose a very high risk of infertility, while the risk of infertility is significantly increased if both testicles are affected. If the treatment of undescended testicles is delayed for a long time, the situation may worsen in terms of infertility. That is why men diagnosed with undescended testicles need to be treated as soon as possible.
Testicular cancer is more common in people with undescended testicles. The risk of cancer is higher when the testicle is in the abdomen than when it is in the groin. Again, the risk is also greater in people who do not descend both testicles. Surgically lowering an undescended testicle can reduce the risk of cancer, but it does not completely eliminate it.
Testicular torsion is an entanglement of the spermatic cord. The spermatic cord is a structure that contains blood vessels, nerves, and a tube that allows sperm to pass from the testicle to the penis. The torsion of this structure causes the current coming to the testicle to stop. It is a rather painful condition. If urgent intervention is not taken after the blood flow stops, the testicle may be lost. In people with undescended testicles, torsion occurs 10 times more often than in society.
In the case where the undescended testicle is located in the groin, the testicles may become open to trauma. It can be injured as a result of an impact from the outside.
Inguinal hernia is another condition that can also be seen in people with undescended testicles.
How is an Undescended Testicle Diagnosed?
• When it is noticed that there is no testicle in the scrotum singly or bilaterally after delivery, the doctor performs an undescended testicle examination.
• The path of the testicles from the abdomen to the scrotum is palpated (examined by touching manually) to try to determine the location of the testicle. In most cases, this will be enough. However, in cases where the location of the testicle cannot be determined by palpation, the laparoscopic method is preferred.
• In the laparoscopic method, a small incision is made on the patient's abdomen and a thin tube with a camera at the end is advanced into the abdomen through this incision. With the help of the camera, the undescended testicle tries to determine its location. The advantage of the laparoscopic method is that the doctor can lower the testicle into place, the location of which he determines during this procedure. In other words, the laparoscopic method can be used both as a diagnostic and therapeutic method. However, in some cases, this method is not enough to lower the testicle and October need additional procedures.
* Open surgery, in which a large incision is made on the abdomen and the abdomen is opened and the undescended testicle is searched, may also be necessary in some cases.
* Imaging methods such as X-ray and ultrasound can also be used by the doctor in the diagnosis.
A condition in which the testicle cannot be felt in the scrotum is testicular agenesis. In this case, the testicle may not have formed at all in the womb, or it may have stopped at a very early stage of its development. In testicular agenesis, the testicle is absent at all and, accordingly, serious consequences can occur. In cases where the testicles are not felt during the examination and the testicular structure is not seen by various methods such as laparoscopic method, the absence of testicles should come to mind. MRI taken using a contrast medium can be used to show the absence of testicles.
What are the Treatment Methods for Undescended Testicles?
In babies with undescended testicles, the testicles can spontaneously descend into the scrotum by 3-6 months. if babies older than 6 months still have undescended testicles, they need to be treated. When an undescended testicle is left untreated for a long time, the risk of many undesirable effects increases. That is why it is recommended that undescended testicular surgery be performed before 18 months.
In the surgical method; the testicle is carefully lowered from where it is located to the scrotum and fixed in place. This method is also called orchiopexy. It can be performed by laparoxopic or open surgery method. The success rate of orchiopexy in the treatment of single undescended testicles is close to 100%.
In some cases, the testicle may have become an underdeveloped, abnormal, or dead tissue. The surgeon removes testicular tissue of impaired structure in such cases.
An undescended testicle may be associated with an inguinal hernia. Those who have undescended testicle surgery can also be treated for hernia repair during surgery.
After undescended testicular surgery, patients are followed up in terms of whether the testicle remains in place, continues to develop, and performs its function. In the follow-up examination methods of imaging the testicle with ultrasound and measuring hormone levels are used.
Hormone therapy is a method aimed at replacing the undescended testicle with the introduction of hormones from the outside. The hormone HCG (human chorionic gonadotropin), given by injection, can make the testicles descend into place. The chances of success of hormone therapy are lower than surgery. That is why the first option in the treatment of undescended testicles is surgery.