As new parents, there are various health considerations to keep in mind for your newborn. One condition that requires attention is undescended testes.
This affects many baby boys globally and understanding its implications and treatments is crucial for ensuring the best outcomes for your child.
Before the baby is born, the testes develop within the abdomen of the fetus and gradually drop to the scrotum, passing through a tube-like channel in the groin called the inguinal canal. This process is normally completed by around the 8th month of pregnancy.
The exact cause of undescended testes is unknown. Environmental factors and genetic predispositions may play a role. Exposure to endocrine-disrupting chemicals during pregnancy, such as pesticides, can increase the risk. Genetic abnormalities and familial patterns suggest that it can also be inherited. There is a seven percent chance that the brother of a boy born with undescended testes will have the same condition. In addition, some pregnancy-related conditions, such as diabetes, obesity, and smoking, may be linked to a higher occurrence of the condition.
The tell-tale signs
More often than not, parents/ primary caregivers are the first to detect the problem. Typically, boys with undescended testes will have no symptoms of pain or discomfort. However, one may note that the scrotum is full on one side and empty on the other. The scrotum may appear small and underdeveloped. One may also note that sometimes the testis is visible in the scrotum and sometimes it disappears (retractile testes). In addition, one may note a swelling in the groin (hernia) or fluid in the scrotum (hydrocele). Often, these are noted during bathing or when changing the baby’s diapers. In older children, the condition may be noted during ritual circumcision.
Detection and diagnosis
Early detection is key. Paediatricians routinely check for undescended testes during newborn exams and on follow-up baby and immunisation clinic visits. The condition is often identified through a physical examination where the clinician palpates the groin and scrotum to locate the position of the testes.
If left untreated, undescended testes can lead to several serious health issues, including:
Subfertility: The higher temperature inside the abdomen can reduce the ability of the testis to produce sperm. It may also affect the quality of the sperm produced. Furthermore, the rate of growth of the testicle may be reduced.
Testicular cancer: Boys with untreated undescended testes have a higher risk of developing testicular cancer. The risk is higher for undescended testes that are in the abdomen and if corrective surgery is delayed after the onset of puberty. The peak age at detection is between 20 and 40 years.
Hernias and testicular torsion: The abnormal position of the testis can lead to hernias. This is the persistence of the tube-like passage in the groin region called the inguinal canal, through which part of the small intestines may herniate and get entrapped. Furthermore, there is an increased risk of testicular torsion, whereby, due to the abnormal location, the testicle may twist on itself, cutting off its blood supply. In addition, the testicle may get injured in the event of a fall or a blow to the groin region.
How is undescended testes treated?
Treating undescended testes is essential to preventing long-term complications. The primary treatment method is surgical correction, known as orchiopexy. This surgery should ideally be performed between 6 and 12 months of age to maximise the chances of future fertility and reduce cancer risk. Medical treatment with hormonal therapies has been tried previously. However, the effectiveness is low and the adverse effects of the treatments are unknown.
Dr Irungu is a pediatric surgeon and senior lecturer at Aga Khan University Hospital Nairobi.
