With tears in her eyes, a mother and a father with worried looks entered my room, holding their little baby. The pediatricians had said they couldn’t find the baby’s single testicle. Even on ultrasound, the testis couldn’t be seen. During examination, the testis really couldn’t be felt. The family was told that the testis could be inside the abdomen, might not have developed at all, might have been lost due to a vascular problem in the mother’s womb, or could be in a different location than usual. They were informed that ultrasound could be misleading in these cases. When the baby turned 8 months old, we inserted a camera through his belly button and saw that it had settled inside the abdomen. We brought it down.
In this section of the Pediatric Surgeon’s journal, I have provided brief information about babies with a single testicle.
Let me give you some additional information about this condition.
In 2-5% of full-term babies and 30% of premature babies, there may be no testis in the scrotum. About 70% of these cases can self-correct by the age of 1. So, the rate of not having a testis in the scrotum in babies around 1 year old is about 1%. This is not a small percentage. In about 10% of these children, neither testis has descended into the scrotum.
The most effective method for diagnosing undescended testicles is physical examination. We can get information about the location and size of the testis
just by feeling it with our hands. But in about 20% of these children, we cannot find the testis manually. We only need ultrasound to monitor the size of the testis in cases where we cannot make a surgical decision or in obese children where we cannot feel the testis in the fatty tissue. Otherwise, the success rate of ultrasound or MRI in finding a non-palpable testis is very low.
We couldn’t find the testis. What do we do?
The fact that we cannot find the testis manually or see it on ultrasound does not mean that it does not exist. There is a study where only 41% of non-palpable testes were truly not found during surgery. About 20% were found in the abdomen, 30% in the inguinal canal, and 9% were found in different locations because they deviated from the descent route.
So, we don’t give up just because we couldn’t find the testis.
If there are accompanying problems such as hypospadias, we check for disorders of sexual development. Especially if both testes cannot be felt, there may be problems that could be life-threatening, so we request genetic testing, karyotype analysis, ultrasound to check for ovaries and uterus inside, and hormone tests for possible adrenal gland problems.
If there are no accompanying problems and there is only one non-palpable testis, the procedure to be done is clear and straightforward: Laparoscopy.
If there is a testis in the abdomen that we see with the camera inserted through the belly button, we bring it down, and if it has atrophied, we remove it along with its remnants.
You can find more detailed videos about undescended testicles in my previous entries in the Pediatric Surgeon’s Journal.
If you want to watch the youtube video, please click.
Let’s finish this course here.
Stay well.
Prof. Dr. Egemen Eroğlu
January 2024