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Undescended testicle

admin — Wed, 03 Sep 2008 17:53:25 -0700

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Male reproductive anatomy

Male reproductive system

HEALTH GUIDE REFERENCE FROM A.D.A.M

Definition

Undescended testicle occurs when one or both testicles fail to move into the scrotum before birth.

Alternative Names

Cryptorchidism; Empty scrotum - undescended testes; Scrotum - empty (undescended testes); Monorchism; Vanished testes - undescended

Causes, incidence, and risk factors

Undescended testicles are fairly common in premature infants. They occur in about 3 - 4% of full-term infants. In most cases the testicles descend by the time the child is 9 months old.

Once a testicle has been discovered in the scrotum it is generally considered descended, even if it is temporarily pulled back (retracted) on a later examination.

Sometimes a condition called retractile testes will develop. In this condition, the health care provider can sometimes locate the testicles and sometimes not.

This occurs because of the strength of the muscle reflex (cremasteric reflex) that retracts the testicles and the small size of the testicles before puberty. In this instance, the testicles descend at puberty. This is considered a type of normal. Surgical correction is not needed.

Testicles that do not descend by the time the child is 1 year old should be carefully evaluated. Studies suggest that surgery should be done by this age to confirm the diagnosis and to reduce the chances of permanent damage to the testicles.

Testicles that do not naturally descend into the scrotum are considered abnormal. These undescended testicles have an increased likelihood of developing cancer, regardless of whether or not they are brought down into the scrotum.

Bringing the testicle into the scrotum maximizes sperm production and increases the odds of good fertility. It also allows examination for early detection of testicular cancer.

In other cases, such as vanished testis, no testicle may be found, even during a surgical procedure. This may be due to a problem that occurs while the baby was still developing in the mother. It may be present at birth (congenital).

Symptoms

There are usually no symptoms, except that the testicle cannot be found in the scrotum (this may be described as an empty scrotum). Adult males with an undescended testicle may have problems with infertility.

Signs and tests

An examination confirms that one or both of the testicles are not in the scrotum.

The health care provider may or may not be able to feel the undescended testicle in the abdominal wall above the scrotum.

Treatment

Usually the testicle will descend into the scrotum without any intervention during the first year of life. If this does not occur, the child may receive hormone injections (B-HCG or testosterone) to try to bring the testicle into the scrotum.

Surgery (orchiopexy) is the main treatment. Earlier surgery may prevent irreversible damage to the testicles. This damage can cause infertility.

Expectations (prognosis)

Most cases get better on their own, without any treatment. Medical or surgical correction of the condition is usually successful.

About 5% of patients with undescended testicles do not have testicles that can be found at the time of surgery. This is called a vanished or absent testis.

Complications

If one or both testicles do not descend, a man may be infertile later in life. Men who have an undescended testicle at birth are at higher risk of developing testicular cancer in both testes.

Calling your health care provider

Call your child's health care provider if he appears to have an undescended testicle.

Call your provider if you are a male, 15 years or older and you are unsure how to perform testicular self-examination (TSE) to screen for testicular cancer.

References

Schneck FX, Bellinger MF. Abnormalities of the Testes and Scrotum and their Surgical Management. In: Wein AJ. Wein: Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 127.

Review Date: 5/22/2008

Reviewed By: Scott M. Gilbert, MD, Department of Urology, Columbia-Presbyterian Medical Center, New York, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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Source Doc: 1_000973

Testicular torsion repair

admin — Thu, 04 Sep 2008 19:03:19 -0700

Overview

Definition
Description
Indications
Risks
Expectations after surgery
Convalescence
References

Illustrations

Male reproductive anatomy

Testicular torsion repair - series

HEALTH GUIDE REFERENCE FROM A.D.A.M

Definition

Testicular torsion repair is surgery to untangle the twisted spermatic cord that is causing testicular torsion.

Description

Testicular torsion is a problem most often encountered by boys at early puberty or just after birth. However, it can occur at any age. Approximately 1 in 4,000 males are affected.

Torsion occurs when the testicle turns or spins, blocking the flow of blood into the testicle. Prolonged blockage of blood flow causes tissue death in the testicle. It results in pain, swelling, and possible testicular damage. If treatment is not received within 6 - 8 hours, the entire testicle may die and need to be removed.

Testicular torsion repair surgery is usually done under general anesthesia (asleep, no pain). A cut is made in the scrotum, and the testicle is uncoiled. Stitches are used to secure the testicle to the inside of the scrotum. The other unaffected testicle is also secured, because it is at increased risk for torsion at a later date.

Indications

Testicular torsion is considered an emergency. Surgery is usually required. It should be performed within 4 - 6 hours after symptoms begin to save the testicle.

Risks

Risks for any anesthesia are:

Problems breathing
Reactions to medications

Risks for any surgery are:

Bleeding
Infection

Call your doctor if you have:

A general ill feeling
Excessive bleeding at the surgical site
Signs of infection, including fever, chills, muscle aches, and headache

Expectations after surgery

If surgery is performed in time, complete recovery is expected. If one testicle has to be removed, the remaining healthy testicle should provide enough hormones for normal male maturation, sex life, and fertility.

Convalescence

After surgery, ice packs will relieve pain and swelling. You may wear a scrotal support for a week after surgery. Resume normal activity gradually.

References

Ringdahl E. Testicular torsion. Am Fam Physician. 2006;74:1739-1743.

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Source Doc: 1_002994