Treatment. Undescended testicle

An undescended testicle (cryptorchidism) is a condition when the testis fails to migrate down from the groin to the scrotum during fetus development. Leaving this abnormality untreated can lead to complications such as infertility, testicular cancer etc. Therefore, it is essential to diagnose and manage undescended testicle in the early stages of a boy’s life.

Undescended testicle diagnosis

The doctor performs a regular examination of the fetus shortly after the birth. If the healthcare provider determines the absence of a testicle or both testicles in the scrotum, he may suggest additional testing. First of all, the doctor wants to check whether the boy has testes. This analysis is essential because some conditions that cause the absence of testicles can lead to serious health issues when left without proper management.

In case the baby has an undescended testicle, the doctor may propose performing surgery. It aids in the diagnosis and treatment of this condition. There are two commonly used types of surgery:

• Laparoscopy is a procedure where the doctor inserts a tiny tube with a camera into the patient’s abdomen. The insertion of a tube occurs through a small incision. This surgery helps identify a testicle located in the groin. Moreover, it can show that only a tiny non-functional fragment of testicular tissue is present. In this case, this piece of tissue is removed. Alternatively, laparoscopy can determine that there is no testicle at all. In addition, using this surgical procedure, the doctor can relocate the testicle to its proper position. However, some patients need additional surgery.
• Open surgery is the procedure during which the doctor directly explores an abdomen cavity or groin. In some cases, this diagnostical method requires the use of a larger incision.

It is important to note that doctors usually don’t recommend imaging tests like MRI and ultrasound for undescended testicle diagnosis.

Undescended testicle treatment

It is better to treat cryptorchidism early in the boy’s life. Furthermore, managing an undescended testicle before the baby is one year old may decrease the risk of complications development. The general recommendation is to perform the surgery before the toddler is 18 months old.

Cryptorchidism treatment aims to relocate an undescended testicle to its proper position in the scrotum. The options include surgery and hormone treatment.

Surgery

It is a commonly used method of undescended testicle treatment. The doctor delicately moves the testis into the scrotum and stitches it into the correct position during this procedure. The surgeon can perform it with laparoscopy or open surgery – two methods described earlier. The doctor determines the time for the operation according to the baby’s health condition and procedure difficulty. Generally, he would suggest doing the surgery when the boy is between 6 and 12 months old.

The doctor may decide to use removal surgery when the testicle is underdeveloped, abnormal or dead tissue. Moreover, suppose the boy has part of the intestine bulging into the groin, the condition known as inguinal hernia. In that case, the surgeon can fix it during the operation. This abnormality is one of the complications that can develop due to an undescended testicle.

After the surgery, the doctor will check the testicle to ensure that the organ develops correctly, functions normally, and stays in the right place. To do so, the surgeon may employ:

• physical examinations
• hormone levels tests
• exploration of the scrotum via ultrasound

Hormone treatment

Generally, hormone treatment of cryptorchidism works less effectively than surgery. Therefore, doctors don’t usually suggest the use of this method. Hormone treatment is a course of injections of human chorionic gonadotropin (HCG). The last is a hormone that can lead to the testicle relocation from the groin to the scrotum.

Other treatment methods

Saline testicular prostheses can be implanted if one or both testes are absent. It can happen due to the initial missing of the testicle at birth or if the organ didn’t survive during surgery. It is worth mentioning that saline testicular prostheses give the scrotum a normal appearance. Nevertheless, they cannot perform functions of the original testicle. Therefore, if the baby boy doesn’t have at least one healthy testicle, the doctor would direct him to an endocrinologist. The last is a hormone specialist. An endocrinologist may suggest further hormonal treatment essential to promote puberty and physical maturity.

Prognosis

Most of the time, surgery to repair an undescended testicle is effective. The rate of success is almost 100%. In addition, men who experienced this operation on a single testis have nearly normal fertility. However, if the doctor performed surgery to relocate both testicles, fertility would fall to 65%. Notably, cryptorchidism surgery can reduce the risk of testicular cancer development but doesn’t eliminate it.