Normally, some developmental problems may occur in babies born prematurely.
One of the most common problems is that one or both testicles have not descended, and this is called an undescended testis.
So what is an undescended testis? What are the symptoms, diagnosis and methods?
The testicles are an organ in the ovary in men, about the size of a walnut in adults and a bean in children. Its job is to produce sperm and male hormones. The testicles function more healthily in the ovary in an environment that is approximately 2 degrees lower than the body temperature. Ovarian muscles relax in hot weather and testicles hang down. In cold weather, the muscles contract and the testicles approach the body.
During development in the womb, the testicles of male babies are located in the abdomen next to the kidneys. In the later months of pregnancy, with hormonal or other effects, the testicles settle where they should normally be, namely in the ovaries. A testis that has not descended to its normal place is called an undescended testis. The testis that does not enter the ovary may be in a place other than the normal route. This condition is called ectopic testis. The testis, which cannot descend to its normal place, is exposed to body heat and sperm production is disrupted. There is also the potential for cancer development in undescended testicles.
Testes that fail to descend into the eggs can be found anywhere along the descent route. However, the most common location is the groin area. The exit (60%) or inside (25%) of the inguinal canal, which extends from the abdomen to the ovary, is the most common location.
Undescended testis is more common in babies born prematurely or with low birth weight. It occurs in approximately one in 100 newborn boys.
The testicles, which are in the abdomen before the 32-36 weeks of development in male babies, descend into the scrotum at these stages.
However, in some babies, this process does not occur as it should. In such cases, the testicles may remain in the groin.
There is also the possibility that the testicles may be left in the abdomen or not developed at all. Undescended testis is commonly observed in babies born prematurely.
Such cases are found in approximately 30 percent of preterm babies.
In cases of undescended testis that can develop on one or both sides, it usually descends to the testis at the end of 3 months.
The absence of the testicle can also be called an empty bag. It is possible for the undescended testis to develop due to 6 different reasons.
In the cases of undescended testis encountered to date, no other reason other than these reasons has been encountered.
The testicles need a certain temperature to do their job properly. This temperature is usually 2-4 degrees lower than body temperature. The testicles that do not descend into the bag are affected by high heat, their functions are impaired and in this case they cannot do their job properly. At the same time, if the testicle cannot go down to the place where it should be, that is, into the bag, a situation such as a decrease in its volume may occur.
The risks that this situation may bring may be decreased sperm quality, infertility and cancer. At the same time, inguinal hernia may develop as a low probability.
Like all other routine controls in newborn babies, testicular control should also be done. Generally, undescended testis can be noticed in this first control. Examination by an experienced specialist is usually sufficient for the diagnosis of undescended testis.
If the testicle cannot be found after the physician's examination, then imaging methods can be used. The most commonly used imaging methods in this area are ultrasound and MR. If the testis is not in the groin or in its place, laparoscopic methods can be used.
In general, families express that their child's ovary is empty. When examined by an experienced physician by stroking from the groin to the ovary, it can be noticed whether the testis is in the groin or not.
Ultrasound gives information about the dimensions of the palpable testis in the groin. Manual examination may not always be effective in children who are overweight or cry during examination.
In these cases, ultrasound can give information about the location and dimensions of the testis. MRI or tomography is not recommended for patients who cannot be visualized with ultrasound.
The procedure to be done in such patients is to look into the abdomen with a camera device (laparoscopy) and to try to lower the testicle at the same time if it is detected in the abdomen.
Under normal conditions, the testis is expected to descend within 1 year at the latest. However, it is recommended to treat the testicles that do not fall into place during this period. The treatment option is surgery.
The ideal age range for this surgery is 6-18 months. The operation is usually performed with a 2-3 cm incision just above the groin. The undescended testicle is found and placed in the ovarian sac. Simultaneous inguinal hernia is usually seen and is repaired during the same procedure.
The treatment of undescended testis is surgery. The testicles, which are palpated in the groin or shown with ultrasound, are released with a small incision made in the groin and placed in their normal place in the ovary. In undescended testicles, there may be an inguinal hernia. The treatment of this inguinal hernia is also done at the same time. The patient can be discharged on the same day or the next day after the procedure. After a few days, he can take a bath and return to his normal activities.
For testicles in the abdomen, laparoscopy is used both in locating the testis and in its treatment.
The ideal age for surgery for children with undescended testicles is 6-18 months. As the age of treatment is delayed, the probability of damage to the testis increases. The testicles remaining in the groin may shrink over time and not function.
It is a term used for testicles that go up and down in the groin (retractile testis). When these patients are examined, the testicle easily descends to the egg, but then it can come out on its own. This condition does not require surgery, but periodic control is recommended.
