Undescended testicles are very common occurring in as many as two to five per cent of newborn boys. Often the testicles will descend spontaneously but here, Consultant Urologist, Mr Imran Mushtaq explains how The Portland Hospital treats the one in every 100 patients whose testicles do not descend.
How will parents know if their child’s testicles have not descended?
The descent of the testicle should be checked by the paediatric team at birth and then again at a baby’s six week check-up. If in the meantime parents notice that the scrotum appears to be empty on either one or both sides, and they cannot feel the testes as being down, they should make an appointment to discuss this with their baby’s GP.
Will an undescended testicle move down into the scrotum naturally and by what age should this have happened?
Every child is different but, in the majority of cases, testicles will descend from a slightly high position down to a normal position by the time the child is three months of age. Beyond this age it is unlikely that a testicle will descend any further. The reason for this is that in the first three months after birth there is a higher level of the male hormone testosterone which plays a key role in facilitating the decent of testicle.
What course of action should a parent take if they suspect their child’s testicles have not descended?
Making sure your doctor or nurse performs a very thorough assessment of your child’s testicles at the six week check-up is of critical importance. Sometimes the person doing the six week check-up can mistake scrotal tissue for the testicle and this is why it is really important that the check-up is carried out very carefully. Parents need to be aware that if either one or both testicles have not descended completely into the very bottom part of the scrotum, the child should be referred to a paediatric urologist for a more thorough assessment. The paediatric urologist will then be able to determine if this is a testicle which requires further surgery or not.
At what age should undescended testicles be treated and what does this treatment involve?
For many years the general consensus amongst medical practitioners was that it was best not to move the undescended testicle until a child starts puberty. Scientific studies have since proven that doing so could compromise a child’s future sperm production and for this reason the current medical guidance is that if a child’s testicle has not descended correctly by itself by the time the child is six months of age then surgery should be carried out before the child is a year old.
Does the treatment of palpable and impalpable undescended testicles differ?
Palpable undescended testicles can be felt just above the scrotum whereas impalpable testicles cannot be felt at all because they are positioned higher up in the groin or abdomen. The distinction between a palpable and impalpable undescended testicle is extremely important. If the child has an impalpable testicle, they require a completely different approach to managing this which can involve performing a laparoscopy and a two stage operation to bring the testicle down.
What are the possible health implications of an undescended testicle not being treated before a child is a year old?
Health implications of an untreated undescended testicle can depend upon whether the child has a problem with one or both of their testicles. If a child has one normally descended and one undescended testicle then his fertility rate should be the same as the general population. If both testicles are undescended then his fertility will be reduced significantly to approximately 50 per cent, however. Unfortunately, for children with two impalpable testicles the chance of spontaneous fertility in future life is close to zero.
What are the common misconceptions regarding the management of undescended testicles?
The most common misconception held about undescended testicles is that if left alone the testicle will descend by itself. This is now proven to be incorrect and it is thought that if a testicle has not descended by three months and certainly by six months of age into the very bottom part of the scrotum then it is most unlikely to descend any further.
Another misconception is that if you have an undescended testicle, you have a high risk of developing testicular tumours. This is also not entirely true. There is no doubt that the risk of developing a testicular tumour is increased in the undescended testicle, but the risk however is roughly 8-10 times higher than that posed to the general population.
Are some children more at risk of being born with an undescended testicle?
Premature babies are at greater risk of having an undescended testicle. This is because they are not exposed to the long period of high testosterone levels during the last few months of pregnancy.
For more information about the treatment of male health conditions at The Portland Hospital or to book an appointment with Mr Mushtaq please contact our Children’s Services enquiry line on 020 7390 8020.