Undescended testis (Laparoscopic Orchidopexy)

During the development of the embryo, testicles lie in abdominal cavity. However, during the latter period of pregnancy, they descend into the scrotal region. The major purpose of the testicles is to produce sperm and the male sex hormone, testosterone .The purpose of the scrotum is to create a cooler environment for the testes as sperm cannot grow or develop at the body temperature. During childhood, sperm present in the testicles undergo a maturation process that finally results in the production of mature sperm at puberty.

Cryptorchidism (undescended testes)

Cryptorchidism or Undescended testes is primarily a condition found in newborn babies when either one or both testes have not descended or passed down into the scrotal sac. Ten percent of such cases are bilateral i.e. they involve both testes. Cryptorchidism is usually seen in premature males. This is because it is only in the seventh month of fetal development that the testicles descend from the abdomen into the scrotal sac. If the testicles are undescended i.e. if they have not descended into the scrotum, then the sperm do not mature normally. It can further result in infertility, particularly when both the testicles are affected. Such people are also highly vulnerable to testicular cancer in adulthood. Undescended testes are found in approximately 3 to 5 percent of male babies and in 3 to 4 percent of full-term infants.
Causes :

The exact cause of an undescended testicle isn't known. A combination of genetics, maternal health and other environmental factors might disrupt the hormones, physical changes and nerve activity that influence the development of the testicles and their descend.

Risk Factors :

  • Low birth weight
  • Premature birth
  • Family history of undescended testicles or other problems of genital development
  • Conditions of the fetus that can restrict growth, such as Down syndrome or an abdominal wall defect
  • Alcohol use by the mother during pregnancy
  • Cigarette smoking by the mother or exposure to secondhand smoke

Symptoms

  • A non-palpable testis located in the abdomen
  • Absent or atrophic testis.

Diagnosis:

The diagnosis of undescended testes is made on the basis of a complete medical history and physical examination.

Treatment:

The treatment for Undescended testes is generally determined by your child’s physician based on:

  • The age, health, and medical history of your child
  • The tolerance of the child for certain type of medications, procedures, or therapies
  • Your expectations, opinion or preference

Treatment is recommended for a child usually after six months of age. The only available treatment option for this condition is surgery. This operation is known as Orchidopexy. The operation is performed using general anesthesia. Open surgery is now given up mostly for this particular condition. Laparoscopy is the gold standard for both diagnosis and treatment of undescended testes. All other imaging modalities like USG, CT Scan and MRI are not reliable to find an undescended testes and may occasionally give false positive results. Laparoscopy is the only reliable test as well as treatment to bring the testes out into the scrotum. This surgery is best done after 9 months age but before 2 years. The testes has a high chance of coming down naturally up to 9 months after which it is unlikely to come down on it’s own. The earlier the surgery, the better the development of the testes in the scrotum.

Following the treatment, the testicle generally develops to normal size in the scrotum. On the whole, the treatment offers 98% success rate.

In case Cryptorchidism is not repaired, the following risks may occur as the child develops and matures:

  • Infertility
  • Risk of testicular cancer increases significantly by 30 or 40 years
  • Inguinal hernia : a condition which is marked by weakening in the lower abdominal wall or protrusion of intestines in the inguinal canal
  • Testicular torsion: A condition which involves painful twisting of the testes. This can further result in a significant decrease in the blood supply to the testes)
  • Trauma
  • Psychological implications of an empty scrotum