Testicular Ectopia Or Cryptorchidism or Undescended Testis

DEFINITION

Cryptorchidism is the condition that when one or the two testicles are not located inside the scrotum (bag containing the testicles).

 

GENERAL

The testicles at the beginning of  fetal life, are created inside the abdomen of the fetus. In the sixth to seventh month of pregnancy, passing through the inguinal canal (holes found at the bottom of the muscular abdominal wall) and exiting from the abdomen, traveling almost under the skin to enter and stabilize inside the scrotum.
If this descent somewhere "snagged" we have cryptorchidism, on one or on both sides.
Here we divide the cryptorchidism in two types, depending on the position of the testis.

A) Cryptorchidism with intra-abdominal testis

The testicle at birth has not come out of the belly of the child and hence can not be felt by the hands of the doctor.
 
B) Cryptorchidism with palpable undescended testicles
The testicle is removed from the child's abdomen and can feel between the external opening of the inguinal canal and scrotum.
The testicle located in ectopic position (in cryptorchidism) at birth, has about a 50% chance to continue his descent, to enter and stabilize in the scrotum, alone, during the first year of life. When this happens, it is already evident from the midterm exam, which is done the sixth month of life.
The higher the testicle, the more likely it is to be and dysplastic (slipshod by nature). The intraabdominal testis is often smaller than normal and sometimes highly atrophic.

 

WHY WE OPERATE TESTICULAR ECTOPIA
Nature has put the testicles in the scrotum to live in a 34o C. temperature. When the testis is high, lives at 37o C.
Chronic overheating causes testiclular atrophy, causing the sperm that will be produced later to not be of good quality and thus it causes fertility problems.
The overheating increases too the chances of testicular carcinogenesis. Testicular cancer is cancer of young men and rarely occurs after the age of 40 years.

 

AGE OF THE INTERVENTION
After the age of twelve months grow permanent microscopic damages to cells of the testis are installed in biopsies done on thousands of testes during surgery. International directives from societies of pediatric urology that exist today, require us to proceed to surgery before the age of 12 months.

 

INTERVENTION
The surgery fixation of the testicle in the scrotum is called orchidopexy. The higher the testicle, the more difficult and more time in the surgery. It can take anywhere from 45 minutes to over 2 hours. The orchidopexy has in experienced hands, excellent success rates exceeding 99%. It is performed under general anesthesia and does not require hospitalization. The small patient leaves the hospital, 2-3 hours after surgery. The procedure is painless and rarely require analgesics.
The surgery requires two incisions. The first incision in the lower abdomen allow the preparation of elements from which "hangs" the testiclein order to obtain long enough to descend into the scrotum testicle . In the scrotum is a second small incision, through which the testicle is secured not to be gone up. All stitches are made with absorbable sutures and thus need not be removed after the surgery. In a few months incisions are made invisible.

 

OSCILLANT TESTICLES
Several times the testicles is not completely stable in the scrotum, but go up and down.  In this case, the surgeon with the help of the parents, must understand if the testicle passes most of the day up and is exposed to high temperature. In this case, you need to make orchidopexy.
The clinical examination is of great importance in cases of oscillant testicles. The ultrasound can help in these cases. When an oscillant testis is smaller than the controlateral stable testis, we must operate. In doubt, we should propose orchidopexy, especially since the intervention is now safe, painless, without complications, with very high success rates.

Pediatric Urology
and Endocrine Clinics

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