This is one condition that has no symptoms but needs to be noticed by the parents. Normally the testis is formed inside the abdomen below the kidneys (before birth). During the 7th month of pregnancy, the testis is pulled down and in the 9th month it comes out through the passage and enters the scrotum. At times, due to various reasons – mechanical as well as hormonal, the testis does not fully descend and continues in the abnormal position even after the birth. This can occur on one or both sides. The absence of a visible testis should be noticed by the parents early in life. This testis may be felt in the groin or inguinal region, or it may not be felt at all. If the testis can be felt, no other investigations are required; however, if the testis is not palpable, then, it may be inside the abdomen, deep in the inguinal region, or rarely, it may be absent on that side. To find out, there is no foolproof investigation; but sonography to localize the presence and location of a testis is fairly reliable. If no testis is seen, it does not necessarily mean that it is absent but that it could be in a position difficult to detect by sonography. The child must be examined by a Pediatric Surgeon as soon as the parents detect the absence of the testis even if the child is only a few months old. If the child is below 1 year of age, one can wait and see if the testis comes down on its own which is known to happen. However, if the child is above 1 year when seen, then surgery must be planned early.
Why this hurry for this operation?
There are many reasons; the first and most important is fertility and function of that testis in later life can be permanently affected if the testis remains in the abnormal position for a long time. Lesser is the damage if the correction is done early in life. Abnormality is seen microscopically as early as 2 years of age and progresses rapidly with increasing age without correction. At times, even the opposite normal testis can be affected in function due to prolonged abnormal position of this side testis. Another reason for surgery is that in 70 % of children with this condition, there is an associated hernia which is holding the testis and is preventing it from coming down, and correction of the hernia will automatically free the testis and allow it to come down easily. A third reason is that these non descended testes midway to their final destination are very mobile and are liable to twist causing torsion of the testis leading to infarction & death of that testis by cutting off of the blood supply. A fourth reason for early surgery is that the likelihood of cancer in that testis which may occur later in life is more in non-descended testes and the longer they are allowed to be in an abnormal position, the higher the chances of undergoing malignant changes.
Thus, these testes need to be brought down and fixed in the scrotum latest by the age of 1-½ years of age to get the best results. If the testis is palpable in the inguinal region, it can be easily brought down in one operation, but those, which are not felt and are in the abdomen, may need one or two operations to be fixed in the scrotum.
The operation is done under anesthesia and usually, the child is sent home the same evening or the next day. Healing takes place within 7 days and the boy can resume normal activity in 10 days. Those boys, whose problem is noticed later in life, need to undergo the surgical correction as soon as possible to avoid or minimize the possible complications.
Last updated on 01-04-2005