Undescended testicle, also known as cryptorchidism, in babies can resolve itself before the child’s first birthday but may require surgical intervention if descension does not take place naturally. Highly esteemed consultant paediatric surgeon Mr Anindya Niyogi gives an expert guide to undescended testis for parents including the most common causes of the problem and when emergency treatment is required. The leading specialist also sheds light on the surgical procedures used to correct the position of the testis in babies with undescended testicle.
What is undescended testis?
Undescended testis is a condition where the testis is not in the scrotum. The testis develops inside the abdomen close to where the kidneys are and later descends to the scrotum, usually before the baby is born. If the process of descent is not complete, the result is undescended testis.
What are the main causes?
The exact cause of undescended testis is unknown. Most boys with undescended testis are usually well in themselves. It is more commonly seen in premature babies, where the babies are born before the descent is complete. Some genetic and hormonal factors may play a role as undescended testis can run in families.
If left untreated, can undescended testis cause further problems?
If a baby is born with undescended testis, no immediate treatment is necessary as the testis can continue to descend up to six months of age. However, surgery is recommended before the first birthday if it is still undescended. If left untreated, the testis will gradually lose its ability to produce sperm, leading to reduced fertility. Leaving it untreated also increases the risk of developing testicular cancer.
When is emergency treatment required for an undescended testicle?
Usually, emergency surgery is not required for undescended testis. However, torsion of undescended testis does occur when a painful lump is felt in the groin. This would require emergency surgery to save the testis, though it is likely that the testis would not be able to be saved in most cases.
What is involved in surgery for undescended testis?
Surgery for undescended testis is called orchidopexy. The surgery depends on the position of the testis.
If the testis can be felt in the groin, it can be brought down to the scrotum in a single operation. Usually, there are two scars; one in the groin to free the testis and another in the scrotum to fix it. Dissolvable sutures are used in children.
If the testis is not felt in the groin, then a laparoscopic (keyhole) camera is inserted through the umbilicus to find out if the testis is inside the abdomen. Surgery for intraabdominal testis is done in two stages. The testis has two main blood supplies – the testicular artery coming from the aorta and the artery of the vas, which follows the sperm tube. The testicular artery is short and prevents testicular descent and so is divided in the first stage of surgery, but the testis is left inside the abdomen. The second stage of the procedure is performed after six months. By that time, the artery of the vas grows and becomes the main blood supply to the testis. The testis is brought down to the scrotum with the vas as its stalk. Both stages are usually performed as keyhole surgery. There is a higher risk of losing the testis in a two-stage operation.
Sometimes a testis may be absent or a tiny nubbin. All nubbins are removed. The single remaining testis is usually fixed to prevent torsion of the testis. Torsion or twisting of the testis compromises the blood supply of the testis, leading to permanent damage.
If you are interested in the current guidance on the treatment of undescended testis, please read my article on the website of the British Association of Paediatric Surgeons.
If you are seeking out treatment for your child’s undescended testis and wish to book a consultation with Mr Niyogi, you can do so by visiting his Top Doctors profile.