Testicular Diseases
Undescended Testicle
This situation, which is very common in boys, is the absence of one or both testicles in the scrotum (colloquially, the bag). The testis is mostly in the inguinal canal, but in some cases it may be in the abdomen. Rarely, the testis may not have formed at all. It is encountered in about 3% of term baby boys and some of them can go down to the sac spontaneously until 1 year old. 1% of 1-year-old boys have undescended testicles, and after this period, the possibility of spontaneous descent into the sac is not very likely and treatment is required. The incidence of undescended testes is approximately 10 times higher in male babies born prematurely, that is, prematurely. In undescended testicles, sperm production functions of testicles may be impaired due to temperature irregularity.
Untreated children will have serious infertility problems when they reach reproductive age. Treatment of children with undescended testicles should be carried out after 6 months, as it starts to show its effect on testicles, which causes infertility, after 6 months. After the baby is 6 months old, it is not very meaningful to wait for the testis to descend into the bag by itself and carries a risk in terms of infertility. Apart from infertility, undescended testicles also have a higher risk of developing testicular cancer in the future. It is very important that the testicles in the abdomen are lowered into the bag with treatment, as it will allow early diagnosis in case of cancer development. In the treatment, hormonal or surgical treatment can be planned according to the age of the child and the region where the testis is located. Undescended testis is frequently accompanied by an inguinal hernia, and both conditions are corrected together during surgery. The approach of physicians specializing in Pediatric Urology as a surgical method is "laparoscopic" surgery, known as the "bladeless method". In this way, the treatment is carried out painlessly and on a daily basis.
Before male babies are born, both testicles are in the baby's abdominal cavity. As the baby continues to develop in the womb, the testicles begin to descend into the bag. After the intra-abdominal cavity, they pass through the inguinal region and settle in the scrotum near birth. Rarely, the descent into this bag continues in the first 6 months after birth. If the testicles are not in the bag in a newborn baby, this is called a true undescended testis. Some of the undescended testicles descend until the end of 6 months. This condition should then be treated. It often happens on one side, sometimes on both sides. The important feature of true undescended testis is that one or both testicles are not palpable in the bag.
What is a Retractile (Shy) Testicle?
This situation is different from the above situation. The testicles are occasionally seen in the bag. However, sometimes they disappear by running towards the groin. The approach to this condition is different from the undescended testis.
If the testis is not palpable, what could be the reason?
The testis may have paused while descending after forming in the abdomen. It may be stuck in the inguinal canal and not descended into the bag. It may even be stuck in the snow that has never even started to descend. Sometimes the testicle may be completely absent. The reason for this is that the testis rotates around itself, preventing the blood flow and disappearing by not being fed.
How Is Undescended Testicle Diagnosed?
Examination alone is sufficient for the majority of patients. The testis is palpable. However, in 20% of patients, the testis is not palpable. Nonpalpable testicles are either absent as described above or are not palpable in the groin examination because they are in the abdomen. In this case, imaging methods such as ultrasonography and MRI are not required. The method used to separate these two conditions is laparoscopy. It is the imaging of the abdominal cavity by inserting a thin camera through the hole in the abdominal wall.
Will İt Create Problems İn The Future?
Yes, if undescended testis is not treated. It reduces the chances of having children in the future. The earlier the testicles are lowered into the bag, the less this risk is. Also, unfortunately, the rate of cancer development in these testicles has increased. However, lowering the testis does not reduce this possibility. It creates cosmetic and related psychological problems.
How Long Should I Wait?
In the modern approach, treatment should be done between 6 months and 1 year of age. If there is a hernia on the side of the undescended testis, then surgical treatment should be applied to a 1-month-old baby without waiting, if necessary.
Is Undescended Testicle Treatment Only Surgery?
The common and definitive treatment method is surgery. The success rate is very high. After the testis is exposed in the surgery, the inguinal hernia problem in many undescended testicular patients is also resolved, and the vessels feeding the testis are separated from the adhesions to the surrounding tissues and extended. The testis is attached to the inside of the bag with sutures. In some cases, hormone therapy may be used. It should be used in well-selected patients and its side effects should be explained. It is known that the success of hormone therapy in lowering the testis into the scrotum (bag) is low. In a small number of children, hormone therapy can be tried in the presence of testes very close to stroke. Hormone therapy is given with injections made 2 times a week. During this treatment, the penis and scrotum enlarge, hair growth occurs, and the color of the scrotum becomes darker. The child may be more active than usual during the treatment period. However, this is temporary.
Inguinal Hernia (Hydrocele, Cord Cyst, Varicocele)
Some disorders that manifest themselves in the form of swelling in the groin area are very common in infants and children. Appropriate treatment should be performed after these problems are diagnosed by a pediatric urologist. Child hernias do not occur as a result of strain as in adults. They occur due to the fact that the peritoneal protrusion in the inguinal canal, which should be closed after birth, remains open. When the baby or child cries, the intra-abdominal organs (mostly intestines) due to the increase in intra-abdominal pressure enter this opening and cause hernia. As the intestine is suffocated here, it causes gangrene and can be life-threatening, and should be surgically corrected as soon as possible.
In cases where the opening is narrow, if only intra-abdominal fluid enters through the canal and creates a fluid-filled swelling around the testicle and in the bag, it is called “hydrocele”. Since there is a chance of spontaneous recovery in hydrocele, it can generally be waited for up to 1 year without surgery. Hydroceles that do not disappear or grow after one year of age are operated on. Sometimes, when the canal is closed from above and below and the fluid is trapped in the middle, a cord cyst is mentioned and the treatment is the same as in hydrocele.
Varicocele is the varicose veins of the testes. This situation, which is very common in young men, but can also be seen especially in boys in adolescence, is important because it can cause infertility. Generally, the disease involving the left testicle may cause pain.
Hydrocele
Fluid accumulation that does not cause pain around the testicle is called hydrocele. It often occurs with the accumulation of fluid in the abdomen around the testis during delivery. There are two types of hydrocele.
Of these:
- The relationship of the peritoneum surrounding the communicating testis with the abdominal cavity continues. Through the opening here, the fluid in the abdomen flows around the testis. This is the same mechanism as the indirect hernia, which will be discussed later.
- In non-communicating hydrocele, there is no relationship with the peritoneum. This type usually occurs at an older age.
How is it formed?
The testicles normally form in the abdomen and then take their place in the sac called the scrotum. This event is often completed before birth. In this process, they drag along the peritoneum called the peritoneum. This connection usually closes before birth and the membrane becomes a closed membrane surrounding the testis. However, as described above, if this connection remains open, a hydrocele will occur. Through this opening, the fluid in the abdomen can easily slide around the testicles and into the abdomen. This gives an idea of why the hydrocele's size is variable.
