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Undescended Testes (Malaysia): What should I do if my baby is missing his testes?

Dr. Nada Sudhakaran
Paediatric Surgeon

Undescended Testes or Cryptorchidism: Early intervention can help reduce cancer risk

 Originally published in Easily Sin Chew on 2020-03-20
https://easily.sinchew.com.my/node/2537/ in Mandarin.

Below is a computer generated English translation.

View the Chinese version on this blog HERE

“Why doesn’t my son seem to have” eggs “?” 

This is a question that parents find when their baby’s scrotum looks flat or touched, but this is by no means a shame, but be aware that this may be a congenital deformity cryptorchidism that is common in premature babies, only timely early intervention can prevent your baby’s health from being affected.

Retractable Testicular Vs Undecended Testes (Cryptorchidism)

According to statistics, 3 out of every 100 newborn full-term male babies suffer from cryptorchidism, but this data has an overestimated component because most of the cases are so-called retractile testis. When the child surgeon holds the baby’s testicles tightly during the test and fixes it to the scrotum, but as soon as the baby cries, feels cold, or is afraid, the testicles retract. This is a natural reaction and is not hidden Testis, and of every 100 baby boys, only one baby is a true cryptorchidism and requires surgery to fix the testes.

Cryptotestis (undescended testis) or untested testis means that the baby’s testicles cannot follow the normal trajectory, that is, descend from the groin of the abdominal cavity to the scrotum, but if it is stuck by fibrous tissue during the process of descending to the scrotum Or, because of endocrine abnormalities, causing the testicles to be outside the normal orbit, such as the abdominal cavity or other locations, it is the ectopic testis. In short, the testicles do not reach its true ‘home’.

Whether it is bilateral or unilateral cryptorchidism, it will affect the baby’s health. It is also a common congenital malformation in children. About 85% are unilateral, only 15% are bilateral, and unilateral to the right The number of testes has not decreased, which is related to the occurrence of hernia on the right side in children. The etiology is unknown.

As for retractable testis and cryptorchidism, because the cremaster muscle of a male baby is very active, it can play a role in pulling up the testicles, especially when the baby is sent to the doctor for diagnosis. When fearing or feeling cold or even nervous in the air-conditioned room, the testicles will be pulled and “hidden” when they “wrestle” with the doctor. The doctor must hold it tightly in time. This is a normal physiological reaction, which is common in general In fact, this is also the case in the animal world for male babies. When some male animals encounter dangers such as fighting, their testicles will ‘hide’. Therefore, retractable testicles should not be regarded as a type of cryptorchidism.

The cause of cryptorchidism in babies is unknown, but thankfully there has been no increase in these years. This is different from the increase in another case of reproductive health problems in male infants, namely hypopospadias. The latter believes It is related to environmental pollution, but it is worth noting that although cryptorchidism has not increased significantly, it has a profound impact on the baby’s health, and even affects his future marriage happiness and ability to make people. Intervention at the right time is imperative, and surgery is the only treatment.

Such as hanging in the air shaking the testicles is easy to reverse necrosis

According to animal studies by Professor John Hutson, a professor of paediatric urology at the University of Melbourne, Australia, early surgery can help improve the sperm quality of patients, and babies can be operated at 6 months. A small moving knife may have a higher risk of anesthesia. It is worth noting that if the testicle does not drop to the scrotum when the baby is 6 months old, it will not drop anymore, so surgery is necessary, otherwise it will have a great impact on the baby’s health, including:

1) Testicular torsion
2) Insufficient sperm (may have azoospermia in the future)
3) Testicular cancer is more likely than normal
4) Appearance is abnormal (causing psychological shadow)

The principle of trauma caused by torsion of the testicles is like an apple hanging in the air. Because it is not fixed, it is not only easy to be injured, but also may be twisted and knotted. If it is not treated within 6 hours, the testicles will be lost Blood circulation and necrosis, in addition to the baby’s pain, will also cause permanent damage to him, not to be ignored.

About 10% of the diagnosed patients are impalpable testis. Half of them are missing testes, that is, the fetus is twisted and necrotic or completely absent from the testis while the other half is found elsewhere.

As for the baby after surgery, although there were cryptorchidism unilaterally or bilaterally, the difference in fertility between the two in the future is not much, but the sperm quality and male hormones are inevitably slightly weaker than normal people, but it basically does not affect Reproductive function.

Cancer risk reduced to 0.4% before surgery

When the fetus is 10 weeks in the womb, the testicles gradually form in the posterior abdominal cavity. Its function is to produce sperm and secrete androgens. After the baby is born, due to abdominal pressure plus the weight of the testicles, it will drop from the groin to The scrotum, but there are two conditions that can cause this process to deviate, namely endocrine abnormalities and blockage of fibrous tissue.

Parents can observe whether there is an abnormality by taking a bath and sleeping when the baby is sleeping. If there is a difference in the baby’s scrotum, for example, if you do not feel the testicles when you touch it, or if it is empty, you can take the child to a child surgeon for consultation Detailed examination; ultrasound is not helpful for examining the baby’s cryptorchidism, and often even artifacts appear, so the doctor’s palpation and the use of laparoscopy for intra-abdominal examination are better.

It is worth noting that the temperature in the scrotum is different from the abdominal cavity by about 1 degree, but the difference in this degree determines the healthy development of the testes. Therefore, if the parents do not detect it, the baby’s testicles will be outside the scrotum for a long time. Another kind of injury, that is, the risk of testicular cancer, will occur. Due to the high temperature, testes are prone to malignant cells and even tumors.

From the data point of view, the risk of normal people suffering from testicular cancer is about 1 in 1,000 people. If a baby with cryptorchidism completes surgery before 2 years old, the risk of cancer is 0.4% (that is, 4 of 1000 people). Studies have shown that if the child does surgery after the age of 12, the risk of cancer increases to 10 or more per 1,000 people, in other words, the danger of cryptorchidism is slighted, and he will face a surge of 2.5 times in the future. Risk; therefore, in addition to maintaining the function of the testicles, another key point of the surgical treatment is to ensure that the testicles are in the scrotum. Once abnormalities such as malignant changes occur, they can be detected in time.


High cryptorchid laparoscopy

There are two main types of cryptorchidism surgery. The first is traditional surgery and the other is laparoscopic surgery. If the testicles can be palpated in the baby’s groin, traditional surgery can be performed here, but If the testes cannot be found by palpation, then laparoscopy must be considered.

For traditional surgery, the doctor first cuts in the groin to find the testicles, then pulls the testicles to the scrotum and fixes them. The operation time will not be too long. The baby can be discharged on the same day, and return to the clinic 3 days later, and 3 months later Then come back to check the testicle quality.

However, if the cryptorchidism is high, that is, the testicles are “hidden” in the abdominal cavity, which is a minimally invasive keyhole laparoscopic surgery, you can flex your muscles. If atrophy or necrosis has occurred, orchiectomy can be performed to avoid becoming a factor of canceration in the future.

If the testicles are normal in size, it is the first stage to observe whether the length of the spermatic cord is enough to reach the scrotum. The second stage of testicular fixation surgery is performed 3 months later. The surgical wound is extremely small, and future scars are not obvious.

Do not sew immune barriers

In addition, testicular cells have only one chromosomal cell, which belongs to the immune privilege zone. Autoantigens are located here. Due to the immune barrier, autoreactive lymphocytes cannot contact them. Therefore, doctors make special ‘bags’ to stabilize it when performing testicular fixation surgery without sewing, because once the immune barrier is damaged, the autoimmune response may be induced, and the consequences can be large or small.

Whether it is traditional surgery or laparoscopic surgery, the treatment purpose is the same, that is:

1) Avoid the risk of twisting and injury to the testicles
2) Improve sperm quality
3) Reduce the risk of cancer and be able to detect it in time
4) Make the appearance correct and beautiful

In addition, cryptorchidism is accompanied by several congenital anomalies in children, including lower belly hernia and gastroschisis. When performing cryptorchidism surgery, doctors can also deal with it.

Preterm infants risk more than double

Premature infants have a higher risk of cryptorchidism than full-moon babies, but doctors must wait until the full term of this premature baby to determine whether they have cryptorchidism. From the data point of view, the incidence of premature Will be more than twice as high as a full-term baby.

However, cryptorchidism is not limited to a certain ethnic group, and there is no difference in the global data. Therefore, parents of premature babies must pay attention to it.

The last point to mention is that October is the Women’s Health Month. From the Pink Ribbon Campaign, it shows that women value the self-health test. In fact, many people don’t know that November is also the Men’s Health Month, which has been implemented in some hospitals. In November, men’s self-examination activities, especially for the health of the prostate and testicles, have not been heated due to insufficient promotion.

If men can also pay more attention to their own health like women, or if fathers pay more attention to the health of their sons, I believe that more male diseases such as cryptorchidism will be detected early and treated in a timely manner, and the risks will be greatly reduced.

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About Dr. Nada

Dr Nada Sudhakaran is a consultant Paediatric Surgeon providing specialized children surgery and based in Kuala Lumpur Malaysia. He has extensive experience in reconstructive paediatric surgery, with a special interest in Minimally Invasive Surgery (keyhole surgery). He is on the specialist register to practice Paediatric Surgery in UK, Malaysia and Australia

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