Testicles are first formed in the back wall of the abdomen during the development process in the womb. Then, under the influence of hormonal and mechanical factors, they move downward and pass through the inguinal canal and reach the scrotum. This descent is completed within the last three months of pregnancy or just after birth.
If the testicles are not in the scrotum in the new-born baby, there may be following 3 reasons for this situation.
- The testicles may not have completed their descent from the abdomen and may remain in the inguinal canal or at a point in the abdomen. This condition is called undescended testicle.
- The testicle may not have developed at all or may have prenatally disappeared.
- The testicle is not located at a point on the normal descent path but is located at a different point (ectopic testis).
What is a Retractile Testicle?
In some children, testicles called retractile testicles, sometimes descending into the scrotum and sometimes upward can be seen. This is due to the overactivity of the cremasteric muscle, and the approach is different from the undescended testis. It is necessary to distinguish between retractile and undescended testis by a specialist. 1/3 of these cases turn into undescended testis in time, so they should be kept under close follow-up.
What is the prevalence of Undescended Testicles?
It is one of the most frequently observed genital anomalies, it is observed at a rate of 1-4% timely delivered babies and up to 45% in premature births. In the first 3 months after birth, 70-77% of the undescended testicles descend into the scrotum spontaneously. After the sixth month, the possibility of spontaneous descending is very low (6%).
Although the reasons for undescended testis are not known exactly, it is estimated that they are caused by some genetic and environmental factors (such as hormonal disruptors).
What are the risks of undescended testicles?
Undescended testicle may predispose to the development of infertility or testicular cancer in the future. Sometimes it can be with inguinal hernia. The earlier the testicle is lowered, the lower the risk of developing infertility. The issue of reducing the risk of cancer development is controversial, but the tumour developing in the descended testicle is easier to detect by palpation.
How to diagnose?
First of all, the testicles are examined by hand to see if they are palpable. If they cannot be felt in the scrotum or groin during palpation (20%),
- It may be in the abdomen or in the mouth of the canal (50-60%).
- Small testicle (atrophic or rudimentary) (30%) in the canal
- Testicle is not developed at all or has disappeared (20%)
Imaging methods (such as MRI, Ultrasound) have no meaning in order to make this distinction, laparoscopy is required to distinguish. Laparoscopy is the process of imaging the inside of the abdomen with the help of an optic inserted through a hole.
The recommended prevalence for treatment is between 6 months and 1 year old. It is recommended to wait for the first 6 months due to the high descension rate of the testicles. After the eighteenth month, the process of deterioration begins in the structure of sperm-producing cells and testosterone-producing cells. For this reason, 6 months – 1 age range is considered as the ideal time. The surest treatment method is surgery. With surgery, the testicles are lowered to their place in the scrotum.
Hormone therapy is not preferred much nowadays because of its low chance of success (20%) and its side effects (hair growth, negative effects on sperm cells, etc.).
NOTE: The page content is for informational purposes only, please consult your doctor for diagnosis and treatment.