{"id":1685,"date":"2021-08-24T16:11:43","date_gmt":"2021-08-24T13:11:43","guid":{"rendered":"https:\/\/dregemeneroglu.com\/inmemis-testisi-ne-zaman-nasil-tedavi-ediyoruz\/"},"modified":"2021-08-24T16:16:38","modified_gmt":"2021-08-24T13:16:38","slug":"inmemis-testisi-ne-zaman-nasil-tedavi-ediyoruz","status":"publish","type":"post","link":"https:\/\/dregemeneroglu.com\/en\/inmemis-testisi-ne-zaman-nasil-tedavi-ediyoruz\/","title":{"rendered":"When and how do we treat undescended testicles?"},"content":{"rendered":"<h5 style=\"text-align: justify;\"><\/h5>\n<h5 style=\"text-align: justify;\"><span style=\"font-family: arial, helvetica, sans-serif; font-size: 15px;\">In our previous courses,<a href=\"https:\/\/dregemeneroglu.com\/inmemis-testis-nedir-neden-olur-neden-tedavi-edimelidir\/\"> <strong><span style=\"text-decoration: underline; color: #3366ff;\">I explained what an undescended testicle is and how we evaluate it<\/span><\/strong>.<\/a>\u00a0 In this pediatric surgeon&#8217;s journal, I explained when and how we treated the undescended testis.<\/span><\/h5>\n<h5 style=\"text-align: justify;\"><\/h5>\n<h5 style=\"text-align: justify;\"><span style=\"font-family: arial, helvetica, sans-serif; font-size: 15px;\">Let&#8217;s first clarify our purpose in the treatment of undescended testis.\u00a0 The aim is to fix the testis to the visible place where it should be normal, that is, inside the sack.<\/span><\/h5>\n<h5 style=\"text-align: justify;\"><\/h5>\n<h5 style=\"text-align: justify;\"><span style=\"font-family: arial, helvetica, sans-serif; font-size: 15px;\">Why do we do this?<\/span><\/h5>\n<h5 style=\"text-align: justify;\"><span style=\"font-family: arial, helvetica, sans-serif; font-size: 15px;\">To reduce the risk of torsion, to prevent damage to the testis in case of possible blunt trauma, to reduce reproductive damage, to allow the person to self-examine in case of developing testicular cancer, and to increase psychological self-confidence by ensuring that both testicles are in the bag.<\/span><\/h5>\n<h5 style=\"text-align: justify;\"><\/h5>\n<h5 style=\"text-align: justify;\"><span style=\"font-family: arial, helvetica, sans-serif; font-size: 15px;\">I will talk about two types of treatment: surgical and hormonal.<\/span><\/h5>\n<h5 style=\"text-align: justify;\"><\/h5>\n<h5 style=\"text-align: justify;\"><span style=\"font-family: arial, helvetica, sans-serif; font-size: 15px;\">The treatment of true undescended testis is surgery.\u00a0 Hormonal therapy can be used in between cases.<\/span><\/h5>\n<h5 style=\"text-align: justify;\"><\/h5>\n<h5 style=\"text-align: justify;\"><span style=\"font-family: arial, helvetica, sans-serif; font-size: 15px;\">When will the surgery be performed?<\/span><\/h5>\n<h5 style=\"text-align: justify;\"><span style=\"font-family: arial, helvetica, sans-serif; font-size: 15px;\">After the birth of the accepted babies, the descent process of the testicles may continue for another 4-6 months.\u00a0 In this case, we do not perform surgery before 6 months, unless there are conditions that may force us, such as hernia or torsion.\u00a0 It is known that the growth and reproductive potential of the testicles of children who have had surgery before the age of two are increased.\u00a0 In the testicular biopsies performed at the age of three, it was determined that there were permanent damages in some reproductive cells.\u00a0 This means that after 6 months, before the age of two, it is necessary to lower the testicles into their proper position, which is inside the scrotum.\u00a0 But if there is an inguinal hernia, at the first appropriate time, preferably within fifteen days after diagnosis.\u00a0 If torsion has developed, it is appropriate to operate immediately.<\/span><\/h5>\n<h5 style=\"text-align: justify;\"><\/h5>\n<h5 style=\"text-align: justify;\"><span style=\"font-family: arial, helvetica, sans-serif; font-size: 15px;\">What is our routine in our clinical practice?<\/span><\/h5>\n<h5 style=\"text-align: justify;\"><span style=\"font-family: arial, helvetica, sans-serif; font-size: 15px;\">We wait up to 9 months after birth.\u00a0 If the testis does not come down, we definitely do the surgery between nine and twelve months.\u00a0 In cases where the testis cannot go down enough despite all kinds of technical maneuvers, it is necessary to wait for a period of six months for the second surgery.\u00a0 Even if there is a requirement for resurgery, with the timing I mentioned, we will have chance to lower the testicles at the age of 18 months at the latest.<\/span><\/h5>\n<h5 style=\"text-align: justify;\"><\/h5>\n<h5 style=\"text-align: justify;\"><span style=\"font-family: arial, helvetica, sans-serif; font-size: 15px;\">Earlier, I told you about a problem called &#8220;ascending testis&#8221;.\u00a0 The testicle of the patient, who is followed up for shy testicles, starts to stay higher and turns into an undescended testis.\u00a0 In these patients, it is necessary to fix the testis by performing surgery within six months after the diagnosis.<\/span><\/h5>\n<h5 style=\"text-align: justify;\"><\/h5>\n<h5 style=\"text-align: justify;\"><span style=\"font-family: arial, helvetica, sans-serif; font-size: 15px;\">What is undescended testicle surgery?\u00a0 How is it done?\u00a0 Do they need to be hospitalized?<\/span><\/h5>\n<h5 style=\"text-align: justify;\"><\/h5>\n<h5 style=\"text-align: justify;\"><span style=\"font-family: arial, helvetica, sans-serif; font-size: 15px;\">We call the operation of fixing the testicle by lowering it into the bag, &#8220;orchidopexy&#8221;.\u00a0 In this surgery, we make an incision on the skin fold line, in the groin area or from the sack, depending on the location of the testis, we free the testis, its vessels and the sperm-carrying duct from the surrounding tissues, and make the testis cord straight and extend it down.\u00a0 I have told you before what an inguinal hernia is. In children with undescended testicles, the canal that causes hernia may be open.\u00a0 In this operation we close this canal, and after repairing the existing hernia, we fix the testicle inside the scrotum.\u00a0 So if we did this surgery by making an incision in the groin, there are going to be two small incisions; both \u00a0in both the groin and the sack.<\/span><\/h5>\n<h5 style=\"text-align: justify;\"><\/h5>\n<h5 style=\"text-align: justify;\"><span style=\"font-family: arial, helvetica, sans-serif; font-size: 15px;\">It&#8217;s not always easy.\u00a0 Sometimes, even if we straighten the cord as much as we want, the testicles cannot be released enough and go down.\u00a0 Then we do technically different maneuvers, sometimes we release from the back of the peritoneum almost to the kidney, we pass it under the veins, we try to somehow lower it down.\u00a0 The surgery can take about 45 minutes.\u00a0 After the operation, we wait for a while and after the recovery is ensured, we discharge on the same day. \u00a0So there is no need for hospitalization.<\/span><\/h5>\n<h5 style=\"text-align: justify;\"><\/h5>\n<h5 style=\"text-align: justify;\"><span style=\"font-family: arial, helvetica, sans-serif; font-size: 15px;\">Post-surgery is usually very comfortable.\u00a0 We do not do any dressing.\u00a0 Two days later, his bandages are removed at home and he begins to take a bath.\u00a0 Five days later, the control time comes.\u00a0 We look for infection in the wound.\u00a0 Then, with the first, third, sixth month and 1-year controls, we look at whether there is a problem in the growth and position of the testis.\u00a0 Young children do not have any movement restrictions, but older children should stay away from activities such as sports and cycling for three weeks.<\/span><\/h5>\n<h5 style=\"text-align: justify;\"><\/h5>\n<h5 style=\"text-align: justify;\"><span style=\"font-family: arial, helvetica, sans-serif; font-size: 15px;\">The success rate of orchidopexy is about 96%.\u00a0 Testicular atrophy, ie shrinkage, can develop at a rate of 2%, due to damage to the testicular vessels during surgery, edema, or not being able to feed in the testis after a serious effort.\u00a0 Other possible problems are infection, bleeding, inguinal hernia and testicular retraction during the healing process.<\/span><\/h5>\n<h5 style=\"text-align: justify;\"><\/h5>\n<h5 style=\"text-align: justify;\"><span style=\"font-family: arial, helvetica, sans-serif; font-size: 15px;\">Let&#8217;s move on to hormonal therapy.<\/span><\/h5>\n<h5 style=\"text-align: justify;\"><span style=\"font-family: arial, helvetica, sans-serif; font-size: 15px;\">As a surgeon, I don&#8217;t recommend it much.\u00a0 We know that testosterone has a place in the descent journey of the testicles from the abdomen to the sack. Therefore, gonadotropin or gonadotropin-releasing hormones to be given externally may play a role in testicular descent.\u00a0 There are publications stating that it can be 10-90 percent successful.\u00a0 But the success is mostly for the testicles outside the canal, close to the sack.\u00a0 As a matter of fact, it is written that hormone therapy is effective in shy testicles, not in real undescended testicles.\u00a0 But I do not recommend treatment for shy testicles anyway.\u00a0 Moreover, hormone administration has side effects such as hair growth, penis enlargement, erections, irritability.\u00a0 Although these problems last up to six months, we do not know much about their long-term effects.<\/span><\/h5>\n<h5 style=\"text-align: justify;\"><\/h5>\n<h5 style=\"text-align: justify;\"><span style=\"font-family: arial, helvetica, sans-serif; font-size: 15px;\">In summary, I do not think that hormone therapy has a place in the treatment of true undescended testicles.\u00a0 Sometimes it can be difficult to distinguish between a shy testis and a true undescended testis.\u00a0 We cannot be sure.\u00a0 We follow up, we make follow up charts, still we can&#8217;t be clear.\u00a0 In such cases, hormones can be used.\u00a0 As a matter of fact, the 2014 American Urology Association statement is not in favor of hormone therapy, it is written in the 2016 European guidelines that it can be used as a supportive treatment before or after surgery.<\/span><\/h5>\n<h5 style=\"text-align: justify;\"><\/h5>\n<h5 style=\"text-align: justify;\"><span style=\"font-family: arial, helvetica, sans-serif; font-size: 15px;\">I want to emphasize it again so that there is no misunderstanding.\u00a0<\/span><\/h5>\n<h5 style=\"text-align: justify;\"><span style=\"font-family: arial, helvetica, sans-serif; font-size: 15px;\">If there is a shy testis, that is, a retractile testis, what we need to do is to follow up.\u00a0 In one study, these children were followed for 3 years and one-third turned to be normal;\u00a0 one third of them turned to be the ascending testis;\u00a0 and it turned out that one-third remained shy.\u00a0 If it turns into an ascending testicle, we operate like an undescended testicle.\u00a0 If it returns to normal, we will stop following.\u00a0 If it continues to be shy, we will follow until we are sure or until puberty.<\/span><\/h5>\n<h5 style=\"text-align: justify;\"><\/h5>\n<h5 style=\"text-align: justify;\"><\/h5>\n<h5 style=\"text-align: justify;\"><\/h5>\n<h5 style=\"text-align: justify;\"><span style=\"font-family: arial, helvetica, sans-serif; font-size: 15px;\">Yes, it has been a long journey.\u00a0 But it is an important and very common issue.\u00a0 Next time I&#8217;ll tell you what to do with the testicles that are never palpable.<\/span><\/h5>\n<h5 style=\"text-align: justify;\"><\/h5>\n<h5 style=\"text-align: justify;\"><\/h5>\n<h5 style=\"text-align: justify;\"><span style=\"font-family: arial, helvetica, sans-serif; font-size: 15px;\">Please <a href=\"https:\/\/www.youtube.com\/watch?v=1WjzlAsN9e8\"><span style=\"text-decoration: underline;\"><strong><span style=\"color: #3366ff; text-decoration: underline;\">click if you want to see the youtube video<\/span><\/strong><\/span><\/a>, follow us on instagram.<\/span><\/h5>\n<h5 style=\"text-align: justify;\"><\/h5>\n<h5 style=\"text-align: justify;\"><span style=\"font-family: arial, helvetica, sans-serif; font-size: 15px;\">\u00a0And stay happy.<\/span><\/h5>\n<h5 style=\"text-align: justify;\"><\/h5>\n<h5 style=\"text-align: justify;\"><span style=\"font-family: arial, helvetica, sans-serif; font-size: 15px;\">Prof. Dr. Egemen Ero\u011flu<\/span><\/h5>\n<h5 style=\"text-align: justify;\"><\/h5>\n","protected":false},"excerpt":{"rendered":"<p>In our previous courses, I explained what an undescended testicle is and how we evaluate it.\u00a0 In this pediatric surgeon&#8217;s journal, I explained when and how we treated the undescended testis. Let&#8217;s first clarify our purpose in the treatment of undescended testis.\u00a0 The aim is to fix the testis to the visible place where it [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":1660,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[35],"tags":[],"class_list":["post-1685","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-blog-en"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>When and how do we treat undescended testicles? - Prof. Dr. Egemen Ero\u011flu<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/dregemeneroglu.com\/en\/inmemis-testisi-ne-zaman-nasil-tedavi-ediyoruz\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"When and how do we treat undescended testicles? - Prof. Dr. Egemen Ero\u011flu\" \/>\n<meta property=\"og:description\" content=\"In our previous courses, I explained what an undescended testicle is and how we evaluate it.\u00a0 In this pediatric surgeon&#8217;s journal, I explained when and how we treated the undescended testis. 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Let&#8217;s first clarify our purpose in the treatment of undescended testis.\u00a0 The aim is to fix the testis to the visible place where it [&hellip;]","og_url":"https:\/\/dregemeneroglu.com\/en\/inmemis-testisi-ne-zaman-nasil-tedavi-ediyoruz\/","og_site_name":"Prof. Dr. Egemen Ero\u011flu","article_publisher":"https:\/\/www.facebook.com\/egemen.eroglu.750","article_published_time":"2021-08-24T13:11:43+00:00","article_modified_time":"2021-08-24T13:16:38+00:00","og_image":[{"width":1920,"height":2560,"url":"https:\/\/dregemeneroglu.com\/wp-content\/uploads\/2021\/06\/2-scaled.jpg","type":"image\/jpeg"}],"author":"Egemen Ero\u011flu","twitter_card":"summary_large_image","twitter_misc":{"Written by":"Egemen Ero\u011flu","Est. reading time":"6 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"Article","@id":"https:\/\/dregemeneroglu.com\/en\/inmemis-testisi-ne-zaman-nasil-tedavi-ediyoruz\/#article","isPartOf":{"@id":"https:\/\/dregemeneroglu.com\/en\/inmemis-testisi-ne-zaman-nasil-tedavi-ediyoruz\/"},"author":{"name":"Egemen Ero\u011flu","@id":"https:\/\/dregemeneroglu.com\/#\/schema\/person\/280787af17547a27921fa0839bcb0a45"},"headline":"When and how do we treat undescended testicles?","datePublished":"2021-08-24T13:11:43+00:00","dateModified":"2021-08-24T13:16:38+00:00","mainEntityOfPage":{"@id":"https:\/\/dregemeneroglu.com\/en\/inmemis-testisi-ne-zaman-nasil-tedavi-ediyoruz\/"},"wordCount":1228,"commentCount":0,"publisher":{"@id":"https:\/\/dregemeneroglu.com\/#organization"},"image":{"@id":"https:\/\/dregemeneroglu.com\/en\/inmemis-testisi-ne-zaman-nasil-tedavi-ediyoruz\/#primaryimage"},"thumbnailUrl":"https:\/\/dregemeneroglu.com\/wp-content\/uploads\/2021\/06\/2-scaled.jpg","articleSection":["Blog"],"inLanguage":"en-US"},{"@type":"WebPage","@id":"https:\/\/dregemeneroglu.com\/en\/inmemis-testisi-ne-zaman-nasil-tedavi-ediyoruz\/","url":"https:\/\/dregemeneroglu.com\/en\/inmemis-testisi-ne-zaman-nasil-tedavi-ediyoruz\/","name":"When and how do we treat undescended testicles? 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