Paediatric Urology – Undescended Testis

U ndescended testis is a medical condition where the testicle does not lie in the normal position within the scrotum. The condition may involve one or both sides.

During normal development of the fetus in the uterus the testicles begin their development inside the abdomen, just below the kidneys. As the baby grows in the womb, the testicles begin to descend slowly into the scrotum via the groin. At the time of birth, most boys have the testicles situated inside the scrotum. In some boys however, the testicles fail to completely descend into the scrotum.

1What causes undescended testis?
The exact causes of undescended testes are not known. It has been found to be more common in boys born prematurely. Fortunately a large proportion of boys born with undescended testes will have normal descent of their testicles within the first year of life.
2Do undescended testicles cause problems?
The main concern with undescended testicles is fertility. Testicles that do not lie inside the scrotum do not mature properly – this often results in poor sperm production. If not corrected early in life, boys with undescended testicles may have difficulty fathering children when they become adults. Undescended testicles also have a higher risk of developing testicular cancer. This definitely does not mean that all boys with undescended testicles will develop cancer later in their lives - undescended testis is a very common condition while testis cancer is quite rare.
3What are the options of treatment for a undescended testis?
• Watchful waiting: Undescended testicles in newborns do not require immediate surgical correction since a majority of the testes will spontaneously descend within the first year of life. • Ochidopexy is the surgical procedure performed to bring the testis down into the scrotum. This operation is done in cases where the testis fails to descend within the first year of life.
4What to expect during surgery for undescended testes?
ation and takes about 45 minutes. The surgery itself is done under general anesthesia whereby the child is put to sleep and he does not feel any pain. A small incision is made in the groin and the testis is pulled down and fixed inside the scrotum. In some cases the operation is performed laparoscopically (using special cameras). Rarely, it may not be possible to get the testicle down into the scrotum during the operation – removal of the testicle is then the only option.
5What are the complications of ochidopexy?
Ochidopexy is generally a safe procedure. Some of the possible complications include: • Infection of surgical wound. • Injury to the nerve of the scrotum – this may later manifest as altered sensation on the side of the scrotum where the surgery was done. • Injury of the blood supply to the testis – if severe, this may cause the testicle to shrink or even disappear completely.