Undescended testes a cause for concern

Donya Betancourt, Pediatrician, Sanur, Bali, drdonya@hotmail.com

Many parents are concerned if their baby boy's testes have not dropped at birth. However, undescended testes is the most common disorder of sexual differentiation in boys, and the medical profession has a 98 percent success rate in treating it.

Thirty percent of premature male newborns are born with an undescended testicle. Three percent to five percent of term male infants are affected by this disorder and by three months of age, the testes have dropped on their own.

By six months, if the testes have not already descended they will remain undescended, which means corrective surgery or other treatment will be required. The testes are located in the scrotum and are responsible for the production of male hormones and sperm.

Development of the testes occurs before the child is born. While the child is in the mothers womb the testes migrate down from high in the child's abdomen and pass through the abdominal wall and groin to take their normal position in the scrotum. If anything happens to stop their movement the result can be undescended testes.

Undescended testicles can be categorized as one of the following: (1) true undescended testicles, including intra- abdominal, peeping at the internal ring (groin area) and canalicular testes, which exist along the normal path of descent and have a normally inserted ligament; (2) ectopic testicles, which have an abnormal ligament insertion; (3) retractile testicles, which are not truly undescended.

"Retractile testes" are due to hyperactive muscles that temporarily pull the testes into the groin. It is important to differentiate between retractile and undescended testes because no hormone or surgical therapy is required for the former condition and it is not believed to injure the testicles.

In a newborn with bilateral, nonpalpable testes (that cannot be found) the child could be a virilized female, so a chromosome study, along with other investigation, will be required.

Why should undescended testicles be of concern?

The first reason is to do with fertility. In humans, the scrotal sac keeps the testes cooler than body temperature. This is important for the development of the testes, as well as for production of normal sperm. Studies have shown that there is an increased risk of infertility in men with a history of undescended testes.

Relocating the testes into the scrotum may decrease the risk of fertility problems, especially if done at an early age.

The second reason is that undescended testes carry an increased risk of cancer. Testicular cancer may not occur until 40 years have elapsed.

Testicular carcinoma is highly curable when detected early, and the best way to do this is through monthly self-examination, which can only be done if the testicles are within the scrotum.

The third reason is to do with cosmetic factors. Also, if injured, the testes can be treated more easily if in the scrotum.

What should be done if a testicle is not palpable on examination?

Early diagnosis and management of the undescended testicle is needed to preserve fertility and improve early detection of testicular malignancy.

Identifying the location of the testes is important because true undescended testicles rarely descend spontaneously after three months of age.

How is an undescended testicle treated?

Treatment for undescended testes is recommended when the child is six months of age and should be completed before he is two years old. There is evidence that early damage to the germ cells that produce sperm begins at this age.

There are two options for treatment. The most effective is surgery, especially when the testes are felt in the groin area. Most testes can be brought down to the scrotum with an operation called orchiopexy. The success rate is 98 percent. In those patients found to have testes very high in the abdomen, additional surgery is required to correct the problem.

Injections of a hormone, HCG, can produce descent in some children. However, success rates have been reported to be as low as 10 percent. Also, the results of hormone treatment are less successful in children less than two years of age.

Any time a child is born with a complication or disorder it is a reason for concern. However, as parents, we can take comfort in knowing that today most complications and disorders are routinely encountered and medical professionals are typically well-versed in the care and management of them.