What is an Undescended Testicle?
As a result of the disruptions that occur during the descent of the testis, the testis can remain at any point along the descent path. The testis, which is the organ responsible for male hormone and sperm production, is not found at birth in approximately 4.3% of babies.
In ¾ of these patients, the testis descends before 3 months. When babies reach one year of age, only 0.96% are undescended. The absence of the testis in the examination is defined as an empty bag, and in this case, the following possibilities exist:
Absence of Testicle
The testis either never formed in the womb or there is loss of the testis due to vascular occlusions that occur after it is formed. It can be single or double sided. Unilateral ones are usually associated with the absence of the ipsilateral kidney.
Testicular Melting (Atrophy)
Although the testis was present before, testicular dissolution has occurred as a result of later effects (occlusion of the vessels, torsion or injury-trauma). In the surgery performed, it is seen that the sperm duct ends in the bag or at a point in the inguinal canal in these patients. In this case, it is recommended to remove the remaining structures.
Undescended Testicle in the Abdomen
Again, there is a testicle that cannot be found on examination. The testis cannot be found by examination, neither in the bag nor in the inguinal canal. It is present in 5-10% of all babies with undescended testicles.
Undescended Testicle in the Canal
It is the most common type that comes to mind when it comes to undescended testis. The testis is palpable at any point within the inguinal canal.
Retracted Testicle
It is a normal reflex that the testicles are temporarily pulled out of the bag (towards the groin) as a result of the contraction of the suspensory muscles. This reflex provides protection of the testis against temperature differences and trauma. Retractile testis is considered not a condition that requires treatment. The distinction between retractile and undescended testicles should be made by a physician.
Ectopic Testicle
The testis is not located at a point on the normal descent path, but shows a different location. Anterior anus, inguinal, penile root, or contralateral pouch locations have been reported.
Symptoms
Undescended Testicle Symptoms
Normally, by the 28th week, the testicles begin to descend slowly in babies. However, sometimes due to hormonal reasons, the testicle cannot descend into the bag, it can remain in the abdomen or on the upper part of the bag.
If the testis does not descend as it should and cannot enter the bag, that is, if it remains in the body, both its volume will decrease and the sperm quality may decrease. In this case, the risk of developing infertility or cancer remains quite high. Again, the probability of being damaged in accidents due to trauma is high. In testicles that do not descend on their own, surgery is absolutely necessary if the physician deems it appropriate.
Diagnostic Methods
Undescended Testicle Diagnostic Methods
The absence of the egg is noticed either by the baby's family or by the doctor. It is an examination that must be done in the normal examination of the newborn baby, and the family must be directed. In the case of testicles that cannot be found on examination, a physician should be consulted.
From time to time, although everything is normal, the testis may not be noticed. If the physician is not able to attend the examination, assistive imaging tools should be used:
In diagnosis, ultrasonography is used to learn the location, relationships and dimensions of the testis and to compare it with the other testis.
Laparoscopy: It is increasingly used in patients who cannot be found in its place and in the groin, both to determine the presence and position of the testis and to intervene for treatment in appropriate cases.
Magnetic resonance imaging (MR or MRI) and computed tomography are used in required patients.
Treatment Methods
Undescended Testicle Treatment Methods
It is applied for both research and treatment purposes in cases of testicle that cannot be found. Concomitant hernias are common. Although it is not found as a symptom, it is encountered in most patients during the operation.
In men, the temperature in the bags is 2-4 degrees lower than body temperature. This temperature is essential for the development and normal functioning of testicular structures. Negative changes occur in the testis in the body due to high temperature.
These changes begin at 6 months. Increasing structural defects can lead to consequences up to the loss of the ability to have children (sterility) when it lasts for a long time.
The testicles, which are removed by surgery, continue their normal development from where they left off. Although the rate of sterility is high among those with a history of undescended testis, it is reported that this rate is low in those who have aborted testicles at an early age.
The probability of malignant tumor arising from the undescended testis is 5-10 times more common than normal. However, it is usually seen after the age of 30-40, and it is reported that this rate does not decrease with the reduction of the testis at an early age, and the issue is controversial.
In the 80's; Surgical treatment, which was delayed until 3 years of age, decreased to 2 years and 1.5 years in the 90s. Today, the general trend is to perform the lowering operation before 12 months, at the latest in the 18th month, instead of the testis.
Operation
Again, it is done in a daysurgery style. Preparation is as in hernia. Usually, hernia repair is also performed together. The technique is simply to place the testicles under the skin of the sac. If there is testicular erosion, the remains must be removed (with the family's permission). Patients should be checked after 2 weeks and after 6 months.
Postoperative
The most common problem is atrophy (testicular melting). Wound infection, relapse, late sperm duct obstruction and inability to have children can be counted as other problems.
Emergencies of Testes and Bags (Acute Scrotum and Testicular Torsion etc.)
Acute (Emergency) scrotum: Red, swollen and painful conditions of the testis indicate an emergency and are defined as acute scrotum. When one or more of these symptoms are seen, they should be considered as a pathology that requires urgent operation until proven otherwise. It is necessary to consult a doctor as soon as possible, and diagnosis and treatment should be done immediately.
A. TESTICULAR ROOTION (TESTIC TORSION)
It occurs as a result of the rotation (360-720 degrees or more torsion) of the testis around its extensions consisting of vessels, nerves and sperm path. Pain in the lower abdomen and groin, nausea and vomiting may accompany the picture.
It should be noted that many patients have a history of stroke (trauma). In cases where the testis is not in the bag, pain in the lower abdomen or groin may indicate an emergency in the undescended testis.
B. OTHER EMERGENCIES RELATING TO TESTES AND BAGS
These symptoms can also be seen in many other diseases of the testicles, which are mentioned below. A physician's support is required to clarify the issue:
Inflammation of the testis and/or the sperm vesicles (epididymis) on it,
Torsion (rotation) of small appendages on the testis called appendix testis,
Subsequent accumulations of water in the bag (acute hydrocele),
Bag swelling of unknown cause but thought to be an allergy (idiopathic scrotal edema),
Bleeding that may develop after a blow (traumatic hematoma),
Testicular tumors (tumors),
Symptoms of some other diseases reflected on testicles and bags, ruptured (perforated) appendicitis and abscess in the bag in a patient with hernia on the same side.
Doppler ultrasonography is helpful in diagnosis if it can be done urgently. By evaluating the blood flow in the testis, torsion-infection distinction can be made. Emergency testicular scintigraphy can be used for diagnosis.
Treatment in Testicular Torsion
In the first 6-8 hours, the operation can save the testicle to a large extent (85-97%). Of course, along with time, the degree of torsion is the determining factor in damage. Testicular viability is less than 10% in those with a history of more than 24 hours.
Torsion is corrected, if there is blood supply, the testis is left in the appropriate position by being fixed (fixed) in the bag. If in doubt, a biopsy (piece) can be taken, but if there is clear tissue death, the testis and its appendages are removed. Since there is a risk of torsion due to similar anatomical features, egg fixation should be performed on the opposite side in the same session.
