Management Of Undescended Testis (UDT)

An undescended testicle (or “testis”) is when it fails to drop into the normal place in the scrotum. This is found in about 3 or 4 out of 100 newborns (and up to 21 out of 100 premature newborns). Luckily, about half of these testicles will drop on their own during the first 6 months of life.

Normal testicles are formed in the lower belly (abdomen), but descend, or “drop,” into the scrotum towards the end of pregnancy. Testicles that don’t drop into the scrotum won’t work normally the reason being, scrotum is many degrees cooler than body temperature, and so is the ideal place for the testicle.

The longer the testicles are too warm, the lower are the chances that the sperm in the testicle will mature normally and testis will tend to get damaged. This can be a cause of infertility, especially when both testicles are affected. UDT are also linked to a higher risk of testicular cancer in adulthood, testicular torsion and developing a hernia near the groin.

A good clinical examination is required to diagnose UDT. If the testicle is palpable in the groin then it is known as a “Palpable UDT”. A testes that can’t be felt in a physical exam is called "Non-palpable." Non-palpable testis may be in the abdomen (undescended), absent, or very small ("atrophic"). A UDT left inside the abdomen could form a tumour later in life.

Unfortunately, there’s no test, such as an ultrasound, that can definitively show whether a testes is present. Laparoscopy is the only ideal way to locate the non-palpable testis.

If the testes won’t drop till 6 months of age, the only treatment of choice is surgery. Surgery is recommended after 6 months of age. Management of UDT which can be felt (Palpable): Surgery for palpable UDT is called “Orchidopexy” and is done as a day care procedure. A cut of about 1 inch long is made in the groin area (hardly visible). The testicles is freed from all nearby tissues so that it moves easily into the scrotum.

For a non-palpable undescended testicle(eg testis inside the abdomen) Laparoscopic Surgery is the treatment of choice. Laparoscopic Surgery is done through thin tubes put into a child’s body through a small cut. The surgeon uses a special camera to see inside the child’s body. By Laparoscopy, surgeon can not only locate the testis but can also confirm the size and then bring the testis down. If the testis is atrophied it can be removed. Some cases of undescended testis in which the testis is lying high up in the abdomen requires two stage surgery.