Correction of Undescended Testis
An undescended testicle is a testicle that hasn't moved into its proper position in the bag of skin hanging below the penis (scrotum) before birth. Usually just one testicle is affected, but about 10 percent of the time both testicles are undescended.
An undescended testicle is uncommon in general, but common among baby boys born prematurely.
The vast majority of the time, the undescended testicle moves into the proper position on its own, within the first few months of life. If your son has an undescended testicle that doesn't correct itself, surgery can relocate the testicle into the scrotum.
Not seeing or feeling a testicle where you would expect it to be in the scrotum is the main sign of an undescended testicle.
Testicles form in the abdomen during fetal development. During the last couple of months of normal fetal development, the testicles gradually descend from the abdomen through a tube-like passageway in the groin (inguinal canal) into the scrotum. With an undescended testicle, that process stops or is delayed.
Complications of Correction of Undescended Testis
In order for testicles to develop and function normally, they need to be slightly cooler than normal body temperature. The scrotum provides this cooler environment. Complications of a testicle not being located where it is supposed to be include:
Testicular cancer. Testicular cancer usually begins in the cells in the testicle that produce immature sperm. What causes these cells to develop into cancer is unknown. Men who've had an undescended testicle have an increased risk of testicular cancer.
The risk is greater for undescended testicles located in the abdomen than in the groin, and when both testicles are affected. Surgically correcting an undescended testicle might decrease, but not eliminate, the risk of future testicular cancer.
- Fertility problems. Low sperm counts, poor sperm quality and decreased fertility are more likely to occur among men who've had an undescended testicle. This can be due to abnormal development of the testicle, and might get worse if the condition goes untreated for an extended period of time.
Other complications related to the abnormal location of the undescended testicle include:
Testicular torsion. Testicular torsion is the twisting of the spermatic cord, which contains blood vessels, nerves and the tube that carries semen from the testicle to the penis. This painful condition cuts off blood to the testicle.
If not treated promptly, this might result in the loss of the testicle. Testicular torsion occurs 10 times more often in undescended testicles than in normal testicles.
- Trauma. If a testicle is located in the groin, it might be damaged from pressure against the pubic bone.
- Inguinal hernia. If the opening between the abdomen and the inguinal canal is too loose, a portion of the intestines can push into the groin.
What Happens During an Undescended Testicle Repair?
Orchiopexy is usually performed on an outpatient basis, which means that your child can go home the same day as the procedure. However, your child may need to stay in the hospital overnight if complications arise during the procedure. Your child shouldn’t be given anything to eat or drink after midnight on the day of the surgery. On the morning of the surgery, you’ll bring your child to the hospital or outpatient clinic.
As the parent, you’ll sign consent forms for the surgery while your child is being prepared in the treatment area. Preparation involves starting intravenous access, or an IV, in a vein in your child’s arm or leg. Your child may feel some mild pain when the IV is inserted, but it’s over quickly.
When it’s time for the surgery to start, an anesthesiologist will inject a general anesthetic into the IV line. This ensures that your child will sleep soundly throughout the procedure.
After your child is asleep, the surgeon will make a small cut into the groin. They’ll then locate the testicle and free the spermatic artery. The spermatic artery holds the testicle in the scrotum. In many cases, a testicle is unable to drop as a result of a short spermatic artery. Freeing the artery from surrounding tissues makes sure that it can be stretched to its full length.
Next, the surgeon will make another small cut in the scrotum, creating a small pouch. The surgeon will then gently draw the testicle down into the scrotum and stitch it securely in place.
Once the procedure is over, the surgeon will close both surgical wounds with sutures or stitches that will eventually dissolve on their own.
Your child will wake up in a recovery room where staff can monitor their vital signs and watch for complications. You’ll likely be able to see and comfort your child while he’s in recovery. Once he’s stable, you can take them home.