Dr. Amrish Vaidya
Undescended testes


What is undescended testis?

When a child is still in the mother’s womb, the testes are much higher in the abdomen. By nine months, they usually descend into the scrotum. When this process of descent is not complete, the scrotum will appear empty. This is called undescended testis.


When the scrotum is empty, is it always due to undescended testes?

Not always. Sometimes the testis can be retractile. This means that though the testis is normally descended, it tends to get pulled up towards the abdomen due to a hyperactive muscle. In such a situation, you may sometimes see the testis in the scrotum, especially when your child is asleep, or sitting cross legged, or in a warm bath.

At times, the testis may not have formed at all, or the testis, having been formed, gets destroyed. Finally, the testis may be an ectopic testis. This appears very similar to an undescended testis, and needs the same treatment. Consultation with a paediatric surgeon should ascertain why the scrotum appears empty.


Does an undescended testis need treatment?

The scrotum has been created to give the best possible environment for the testis to grow, develop and function optimally. If the testis is not in the scrotum, there are issues with its development, and its ability to  produce sperms. Also, testes which are not descended have an increased chance of developing cancers in early adult life. Moreover, there is a greater chance of undergoing a torsion. This means that the testis twists on its stalk. This can cut off its blood supply and can be very harmful to it. For these reasons testes which are not descended need surgery.

Retractile testes generally do not need surgery. Most correct spontaneously by the time the child attains puberty. Sometimes, retractility may cause growth retardation of the affected testicle. If so, the testis may need to be fixed in the scrotum.


When does surgery need to be done?

Surgery should be done preferably before the age of 1 year. There is evidence that the longer the testis stays higher up, the more damage it can cause. This damage is unfortunately permanent.

Is surgery done by the usual method, or by using a laparoscope?

If the testis is visible or palpable in the groin, the open method is used. If, however, the testis cannot be felt, or cannot be seen in the groin by ultrasound scanning, then using a laparoscope is the best method of treatment.
Will more than one operation be needed?

Sometimes, for reasons of anatomy, the testis cannot be brought all the way down into the scrotum in one operation. Another attempt may be needed in this case.

Especially if the testis is in the abdomen, and a laparoscopic technique has been used, a decision may be made to stage the surgery.

Following some manipulation in the abdomen, a second laparoscopy may be needed after 6 or more months.

Undescended testes
An empty scrotum on the child’s left side needs assessment.

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