The undescended testicle, or cryptorchidism, is a deformity where the testicle fails to descend into its normal position within the scrotum, the skin sac behind the penis. This phenomenon can occur in one testicle or, rarely, in both.

Scientific statistics estimate that this condition affects between 2% and 5% of newborns, and it is more common in infants born before the full term of pregnancy or before reaching thirty-seven weeks of gestation.

In most cases, the condition resolves naturally without surgical intervention during the early months after birth. However, if the problem persists, surgical intervention is the solution.

 

The condition is detected during the initial physical examination performed by the doctor on the newborn at birth or during the routine sixth- to eighth-week examination. Then, it is determined whether the newborn has an undescended testicle or not, where the testicle cannot be seen or felt in the expected location inside the scrotum.

 

Undescended testicles are not usually painful, and the child is not at immediate risk of health problems. However, he should be monitored by a doctor in case treatment is needed later on.

 

Some boys may have retractile testicles, a normal temporary reaction, to protect them when the child is cold or scared. The testicles may intermittently appear outside the scrotum, causing concerns about undescended testicles. Usually, the testicles are in the scrotum, but occasionally they temporarily retract into the groin. Retractile testicles do not require treatment because they are a normal condition, but an examination should be performed to differentiate them from undescended testicles.

 

During pregnancy, the testicles form inside the baby's abdomen before slowly moving downward into the scrotum about one or two months before birth.

The exact cause of some children being born with undescended testicles is unknown. Most children with this condition are otherwise healthy.

Certain factors may increase the chances of a boy being born with undescended testicles, including:

• Low birth weight (premature babies).

• Family history of undescended testicles.

• Maternal alcohol or cigarette use during pregnancy.

• Maternal history of type 1 or type 2 diabetes or gestational diabetes.

• Premature birth (before thirty-seven weeks of gestation).

 

For the testicle to function properly, it needs to be in its natural position, which provides a lower temperature than the body temperature. When an undescended testicle occurs, the testicle is exposed to a higher temperature than usual, which can harm its development and its ability to produce sperm in the future. This can lead to serious complications if left untreated, including:

• Fertility problems, including low sperm count, poor sperm quality, and infertility, occur because the testicles need to be cooler than normal body temperature by two to three degrees to produce sperm. The scrotum is much cooler than body temperature, making it the ideal place for the testicle. Testicles that do not descend into the scrotum normally will not function properly. The longer the testicles remain warm, the fewer chances for normal sperm maturation.

• Testicular torsion occurs when the spermatic cord twists, cutting off blood flow to the attached testicle. This condition requires immediate surgery to be repaired. Testicular torsion can cause severe damage to the testicle and may even require its removal if left untreated for a long time.

• Inguinal hernia, part of the intestine has slipped into the groin instead of remaining in the abdomen. The blood flow to the herniated part of the intestine may be cut off, leading to tissue damage. Therefore, an inguinal hernia is considered a medical emergency.

• Increased risk of testicular cancer.

 

The surgical intervention aims to bring the undescended testicle into its natural position inside the scrotum if it does not descend naturally within the first six months. Prof. Dr. Wael Ghanem advises the need for early treatment to avoid further complications such as infertility and testicular cancer.

• The undescended testicle is usually treated with surgery, as Prof. Dr. Wael Ghanem carefully restores the testicle to the scrotum and sutures the opening.

• Hernia may be the cause of the undescended testicle; therefore, it is also treated.

• The hormonal treatment is less efficient than surgery.

 

There are two methods of treatment:

Testicular fixation: If the testicle can be felt in the groin, a simple fixation can be performed. This involves making a surgical incision in the groin to locate the undescended testicle. Then, the testicle is gently moved downward and placed in the scrotum through a second incision.

Laparoscopy: If the testicle is in the abdomen, a laparoscopic procedure is performed to locate it before repositioning it. This involves passing a laparoscope (a small tube with a light source and camera) through a small incision in the abdomen. Once the procedure is complete, the incision is usually closed with dissolvable stitches that do not need removal.

 

Both testicular fixation and laparoscopy are performed under general anesthesia, meaning the child will be asleep during the procedure and not feel any pain. The surgery takes about one hour and is typically done as one day surgery, allowing the child to return home on the same day.

 

In cases where the testicle is not palpable, there is a slight possibility that there is no testicle on that side due to improper development or early atrophy of the testicle, which will be confirmed during the laparoscopy.

 

The following tips should help accelerate your child's recovery time and reduce the risk of any complications:

• The child will need regular pain relief for a few days after the surgery by taking simple painkillers. Activities, including playing games, watching TV, and reading, may help distract the child from the pain.

• Encourage the child to drink plenty of fluids.

• Wearing loose clothing, although wearing a diaper will protect the groin area for some time after the surgery.

• Follow Professor Dr. Wael Ghanem's advice regarding bathing and showering.

• The child should not ride a bike or use sitting toys for a few weeks after the surgery, to prevent the testicles from returning to the abdomen.

• The child should rest at home for a few days before returning to school or nursery.

Professor Dr. Wael Ghanem, a consultant in plastic surgery and congenital defect repair, will continue to monitor the testicle's stability in its position and its ability to perform its natural functions.