Undescended Testes in Babies

When the baby is being formed, the testes are initially made up in the abdomen, near the kidneys. They then go through a process called testicular descent whereby the testes descend down through the abdomen and into the scrotum. Isn’t nature amazing?. However, sometimes the testes fail to descend normally and can be halted at any point along the way, hence the term undescended testes. Most of the time they are halted outside the abdominal cavity and are “stuck” in the groin.

Sometimes though they can be halted inside the abdominal cavity.

Symptoms

Most children do not complain about having undescended testes. It is normally diagnosed at the time of birth or at the 6 week check. Some parents will also notice that the testicle would appear missing when changing the child’s nappy or bath time. Both testes should be present at the base of the scrotum by 3 months of age and if they are not, they will require surgery. Occasionally children will develop an ascending testes, this occurs in older children between the ages of 7 – 11 years old of which the testicle was in a normal position then moves out of the scrotum. Once again, these young boys do not generally notice this change but are spotted by their parents when they are being showered or bathed.

Causes

In reality, we do not really understand as to why children develop undescended testes. It is a very common condition affecting 1 in 100 boys. If a boy has undescended testes, he increases the risk for his relatives having undescended testes, both the siblings and his own children. However, the vast majority cases are spontaneous and there is no distinct cause or risk factor.

Treatments

Without a doubt, the most useful and successful treatment for undescended testes is an Orchidopexy. This consists of an operation which brings the testicle down into the base of the scrotum and fixes it into that position.

Surgery

If the testes are palpable and it can be felt during clinical examination, the operation will consist of an incision in the groin and the testis is freed up. Frequently there is a small hernia present which is repaired at the same time. The testes are brought down into the scrotum, a small incision is made and is placed into a small pouch.

If the testicle is not palpable, a keyhole procedure will occur in which a camera is placed into the abdomen. If the testis is present in a reasonable shape, a two stage procedure will be required in order to bring it down into the scrotum.

Post Surgery

A vast majority will be able to go home the same day and do extremely well.

FAQ’s

Orchidopexy is the name of the operation for bringing undescended testes down into the scrotum. A small cut is made in the groin. The testes are released and a hernia which is present is repaired. Another incision is made in the scrotum and the testes is placed in the correct position.
Testes should be in the scrotum by 3 months of age. If they are not in the correct position then they need an operation to bring them down. Bringing the testes down to the correct position maximises the potential fertility for the child and can decrease their cancer risk.
A general anaesthetic is necessary for orchidopexy. It is very safe and well tolerated by children.
The vast amount of boys will be able to go home on the same day after the operation. Occasionally if both testis are brought down then the child may need to stay one night.
Your son will be brought to the theatre. He will receive general anaesthetic and be given local anaesthetic as well. Two incisions are made, one in the groin to free up the testes and another in the scrotum where the testes are placed.
The risks of orchidopexy are low. The risk from the general anaesthetic is extremely low. Infection, bleeding and swelling can occur in less than 3% of patients. Occasionally the testes is too small and has to be removed. Rarely the testes do not grow or shrinks after the operation and sometimes has to be removed.
Normally boys recover fully within 3 days.
Occasionally there can be some nausea within the first feed hours of the surgery. Baths should be avoided for 5 days. Otherwise regular pain is necessary for the first few days. Other than that the child should be treated normally.
Most boys are able to return to school after 5 days. A few boys go back sooner. Parents are the best judge of their own sons.
After going home from the hospital the only medication you will need is the routine pain analgesics which you will give regularly for the first few days.
There is some evidence relating to hormone usage. However national guidance advises strongly against hormone usage and suggests surgery is the correct option.

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Mr. Feilim Murphy

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