Undescended Testes (UDT)

The testes are two organs (male gonads) that hang in a pouch-like skin sac (the scrotum) below the penis. The testes are where sperm and testosterone (the male sex hormone) are made. The scrotum keeps the testes in a cooler setting than the body. This is because sperm can't grow at body temperature. Normally testes are formedin the lowerabdomen, and descend into the scrotum towards the end of the pregnancy.An undescended testis (UDT) is when it fails to descend into the normal place in the scrotum and about half of these testicles will drop on their own during the first 6 months of life. But the testes will not descend after 6 months of age. Thus, about 1 or 2 out of 100 boys with UDT will need treatment.

Testes that don't drop into the scrotum are in a warm environment. The longer the testes are warm, the lower chances are that the sperm in that testis will mature normally and will start getting damaged. This can be a cause of infertility, especially when both testes are affected. UDT are also linked to a higher risk of testicular cancer in adulthood and testicular torsion (that is rotation of the testis on its axis)

A good clinical examination is required to diagnose UDT. If the testis is palpable in the groin then it is known as a Palpable UDT. A testis that can't be felt in a physical exam is called "Nonpalpable." Nonpalpable testis may be in the abdomen, absent, or very small ("atrophic").

An UDT left inside the abdomen could form a tumor later in life. Unfortunately, there's no test, such as an ultrasound, that can definitively show whether a testis is there. Laparoscopy is the only ideal way to locate nonpalpable testis. If the testeshas not descended till 6 months of age, then the treatment is surgery.  This surgery is called “orchidopexy”. The surgery is done as a day care procedure. A cut of about 1 inch long is made in the groin area. The testis is freed from all nearby tissues so that it moves easily into the scrotum and then it is fixed there.For a nonpalpable UDT Laparoscopic Surgery is thetreatment of choice. Laparoscopic surgery is done through thin tubes put into your child's body through a small cut. The surgeon uses a special camera to see inside your child's body. By laparoscopy surgeon can not only locate the testis but also confirm the size and absence of the testes also bring the testis at the same time. If testis is atrophied it can be removed. In some cases, the testis is lying high up in the abdomen, then it may require two stage surgery.

The child is discharged on the same day.

Dr. Ashish Prasad

Consultant Paediatric Surgery and Paediatric Urology
MBBS, DNB (General Surgery), DNB (Paediatric Surgery)

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