Undescended Testis in male children :
This is a very common problem in our country now a days. Initially immediately after birth in our country & subcontinent LUCS is now very popular. With or without indications LUCS are now performing in every private & govt hospitals. We all know that to born a mature male child at least 37 wks of full term pregnancy is needed. Due to premature delivery & preterm baby have some sorts of physical & biochemical problems in his body. Some are related to hormonal, environmental or genetical. Those are the main triggering factors in case of UDT.
Testis is very vital organ in case of male children. Our society & our family gives more value in a child born with testis rather than a vagina.
Development of testis :
Usually testis is developed from the genital ridge of intermediate mesoderm. The pathway of testis development is given below:
Germinal ridge formation →Sex determination →Sex cord development →Hormonal signals arrangement
Factrs in testicular descend :
Anatomical
Environmental
Genetic
Hormonal
Physical condition
Usually testis is developed 3-5 wks of gestation just behind the kidney. After that testis descend ocvurs along the pathway of descend up to 8-9 months. At 3 months testis is behind the kidney, then at 7 months in deep inguinal ring, at 8 month travels the inguinal canal & 8.5 months in superficial inguinal ring & at 9 months reach to the bottom of the scrotum.
Pathology of testis :
Problems we found :commonly
1.Undescended Testis (Palpable)
2.Undescended Testis(Impalpable)
3.Bilateral undescended testis
4.Retractile testis
Undescended Testis(Palpable)
This one is very common. Due to the interruption in the pathway of descend testis found in inguinal region. On examination after doing milking action we usually found it in inguinal canal. Then we asses the volume, size & characteristics of the testis. Then we send for sonogram, they give clear idea about above factors. Then after doing counselling of the parents we usually perform orchiopexy.
Undescended Testis(Impalpable) :
This in is not so uncommon. In this case tesis found in abdominal cavity. So descend of testis is quite difficult by conventional method. This kind of cases there are so many options. If in ultrasound days testis not ground in inguinal canal, then we advised for MRI of abdomen to locate it. After doing MRI we perform laparoscopic or lap. Assisted Orchiopexy.
Bilateral undescended testis :
Its also common in our subcontinent. Usually if both testis not found in scrotal sac or in inguinal canal we found it in abdomen. Usually there is chance of association with DSD(Disorder of Sexual Differentiation). In this cases we furthermore goes for evaluation like hormonal assay, USG of internal organs & genetic testing e.g. karyotyping.
Retractile testis:
In this type testis comes to bottom of the scrotum when baby is in relax position & goes upward when doing daily activities or crying. Two groups of thoughs are present, one is advising for fixing testis that is orchiopexy & one is advising not to do any surgery.
Common Association with UDT:
In our practice we commonly found inguinal hernia & hypospadias with udt. Usually when we perform orchiopexy usually we ligate the hernial sac. If not performed hernia may recur.
Age of surgery :
Before 1 year of age is recommended.
What to do if your children have this kind of issues :
1.You can wait upto 1 year, usually it descends within 1 year.
2.If you found it after 1 year, consult with your nearest pediatric surgeon
3.If you dont want to do surgery testis may vanish with time
4.If surgery do not performed on time may causes trauma, torsion or tumor
5.If orchiopexy done, baby will be able to produce sperm, cause for sperm production recommended temp.is 32-34 degree Fahrenheit
Problems if DSD found with Bilateral UDT:
1.Needs evaluation
2.Needs hormonal assay
3.Needs multiple surgery
4.Needs counselling session
5.Needs right diagnosis & further procedure
Conclusion :
Undescended testis is treatable if diagnosed properly on time. If you want to learn more, please visit my blog section for detail. Please don’t forget to follow me in Facebook at Shovon Mahmood