Undescended Testis (UDT): 9 Essential Facts About Hidden Testicles in Children
Undescended testis (UDT), medically known as cryptorchidism, is a common pediatric condition where one or both of a baby boy's testicles fail to move into the scrotum (the sac beneath the penis) before birth. During the final months of pregnancy, the testicles typically descend from the abdomen, through the inguinal canal, and into the scrotum. However, in some infants, this migration is interrupted, leaving the testis lodged in the abdomen or the groin. While it can affect full-term infants, it is significantly more prevalent in premature babies.
If left untreated, a "hidden" testicle is exposed to higher body temperatures than the scrotum provides, which can lead to complications such as infertility or an increased risk of testicular cancer later in life. Understanding the types, timing for treatment, and the necessity of surgical intervention is vital for parents to ensure their child's long-term health and development.
1. Defining the Types: Palpable vs. Non-palpable
A pediatric surgeon or urologist first determines the nature of the UDT based on whether the testicle can be felt during a physical examination:
- Palpable: The testicle can be felt in the groin (inguinal canal) but cannot be moved into the scrotum.
- Non-palpable: The testicle cannot be felt at all. In these cases, it may be high up in the abdomen, very small (atrophic), or entirely absent.
2. Common Causes and Risk Factors
The exact cause of UDT is not always clear, but it is often attributed to a combination of genetics, maternal health, and environmental factors. Key factors include:
- Hormonal deficiencies during pregnancy that signal the testicles to descend.
- Structural defects in the path of the testis.
- Developmental issues within the testicle itself.
- Premature birth is a major risk factor, as the descent typically happens late in gestation.
3. Recognizing the Symptoms
UDT does not usually cause pain or discomfort. The primary sign is visual and tactile:
- The scrotum appears empty on one or both sides.
- The scrotum may look smaller or underdeveloped.
- Upon touch, the testicle is not found within the scrotal sac.
4. Diagnosis through Imaging and Laparoscopy
To locate the "hidden" testicle, specialized diagnostic tools are used:
- Ultrasound: Frequently used to identify the position of the testis in the groin.
- Laparoscopy: If the testis is non-palpable, a small camera is inserted into the abdomen to locate it. This tool is unique because it allows for both diagnosis and treatment in the same session.
5. The "Wait and See" Period: 6 Months
It is important to know that many testicles will descend on their own during the first few months of life. Most surgeons recommend waiting until the infant is 6 months old. If the testicle has not reached the scrotum by this age, it is highly unlikely to move on its own, and medical or surgical intervention becomes necessary.
6. Surgical Intervention: Orchidopexy
The standard treatment for UDT is a surgery called **Orchidopexy**. The goal is to move the testicle into the scrotum and stitch it permanently into place.
- This is a delicate operation performed by a pediatric surgeon or urologist.
- For testicles in the groin, an open procedure is common.
- For testicles in the abdomen, laparoscopic orchidopexy is often the preferred method.
7. Anesthesia and Safety Measures
Orchidopexy is a sensitive procedure that requires the child to be completely still; therefore, it is performed under general anesthesia.
- A pediatric anesthesiologist ensures the child is fit for surgery based on pre-operative tests.
- Full or half sedation is necessary to ensure a painless and safe environment for the surgeon to work.
- Following strict fasting guidelines (3–4 hours) is essential for the child's safety during anesthesia.
8. Post-Operative Care and Recovery
Recovery from orchidopexy is usually very smooth. Most children can go home the same day.
- Feeding usually resumes 3–4 hours after surgery with the doctor's permission.
- An IV cannula is used during the stay for fluids and medication.
- Activity should be restricted for a few weeks to prevent the testicle from moving out of its new position.
9. Long-Term Health and Monitoring
The primary reason for surgery is to preserve future fertility and reduce the risk of cancer. Bringing the testicle into the scrotum allows for regular self-exams as the child grows into adulthood. Long-term follow-up with the pediatric surgeon ensures that the testicle continues to grow normally and that its blood supply remains healthy. 250464
