Undescended testes

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Undescended testes is medically called “cryptorchidism”. It means hidden testes. It is a very common condition among new born babies. 3% of all new born male babies has this condition. Early diagnosis and treatment of undescended testes is very important because if untreated, it has negative effects on the testes and future fertility. Males with undescended testes are 40 times as likely to get testicular cancer as the general population. The undescended testes can twist (torsion) and cause great pain. 

Development of the male genital system

There are 2 sex chromosomes in humans. They are X and Y. XX combination in female and XY is male. Human egg cell (oocyte) and sperm cell have half the total number of chromosomes. When the two joins up, the full chromosome complement forms and the resultant zygote develops into baby over nine months inside the womb.

Y chromosome contains an area called the “testes determining region of Y” (SRY). This area produces a protein that triggers testes development. Absence of same triggers ovary development.

Three weeks after fertilization, the embryo is a three-layered cell disk. The middle layer divides in to an area of tissue called the intermediate mesoderm. From this, a small tissue protrusion appears and differentiates into the “gonadal ridge”. Under the influence of the SRY component the gonadal ridge matures into the testes. In a general sense the testes and ovaries develop in the abdomen. Both testes and ovaries descend into the scrotum and pelvic respectively during late development. Until 8th week of intra uterine embryonal development, males and females are indistinguishable externally. After 8th week the external genitalia develop along different lines. After the scrotum develops, the testes descend down from the abdomen in to the scrotum and by 37th week, both testes are in the scrotum.

Causes and risk factors of undescended testes

The exact mechanism of undescended testes is yet undefined. A wide array of factors affect testicular descent. In low birth weight babies, no matter how long the pregnancy is, there is an increased incidence of undescended testes. 23% of the babies with undescended testes has similarly affected relatives. Hormonal defects such as 5- alpha –reductase deficiency, conditions where pressure inside the fetal abdominal cavity is low (prune belly syndrome, omphalocele, cloacal extrophy) give rise to undescended testes.

What are the symptoms and signs?

Usually your doctor examines the baby immediately after birth. Therefore undescended testes is always detected at birth. Undescended testes may have descended along an abnormal route under the skin to upper thigh, lower abdomen, behind the scrotum and may still be inside the abdomen.

What are the tests done to diagnose?

If only one testes is inside the scrotum and there are no defects in the urethra (ex: abnormal opening urethra on the under-side of the penis – hypospadias) your doctor will not prescribe any investigations. If both testes haven’t descended your doctor will prescribe hormone levels such as FSH, LH, 17 - hydroxyprogesterone and testosterone. Ultrasounds scans and other imaging methods are useful to detect associated anomalies.

Treatment and management

If testes is palpable in the pubic area a certain time may be given to allow it to descend spontaneously. If situated at a location where spontaneous descent is unlikely, surgery is indicated. Discuss with your doctor.

There are drugs and surgeries used to treat undescended testes. Human chorionic gonadotrophin and Gonadotrophin releasing hormone treatment causes increased skin pigmentation, penile growth and pubic hair growth. Both drugs have a similar success rate of about 55%.

Surgery involves exploration for undescended testes, manipulation of testes in to the scrotum and fixation to minimize future risk of torsion. 

Clinical management of undescended testes does not end after surgery. Regular follow to detect any complications and long term review to exclude fertility issues are vital components of management.

Dr. T. M. S. Sameera B. Madugalle M.B.,B.S (COL)

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