In children, the testes form inside the abdomen, near the kidneys, in the seventh week of fetal life. Then, in the third trimester, they pass from the abdomen into a canal located in the groin on each side, move down towards the scrotum and settle in the scrotum at around week 36 of pregnancy. If this has not happened by the time of birth, it is called cryptorchidism or undescended testis. This condition is very common in premature babies and in babies born with a low birth weight. It is seen in 30 per cent of premature babies and 3 per cent of full-term babies, and in most cases the testis moves down into the scrotum on its own by the age of three months.
If the testis has not moved down into the scrotum by six months of age, it must be treated. Cause: the main cause is not yet known, but hereditary and hormonal factors may play a part. Symptoms: there are usually no symptoms, and the most important finding in these children is an empty scrotum. Sometimes, because the condition occurs together with a hernia or hydrocele, the parents notice a bulge in the groin.
In some cases, because the testis has not come down far enough and is not fixed in place, the testis twists (torsion), which is painful; in this case you must see a doctor urgently.
Diagnosis: a definite diagnosis is made by the doctor's examination. In 80 per cent of cases the doctor can feel the testis in the groin, but in other cases ultrasound, MRI and laparoscopy may be used to make an accurate diagnosis. Treatment: if the testis has not come down by six months of age, the main treatment is surgery. In this operation, the surgeon brings the testis down into the scrotum and stitches it in place. The best age for the operation is 6–9 months.
Outlook: the operation is successful in most cases. If the parents follow the advice on care after the operation, there will be no particular problems.
Long-term complications: infertility – timely treatment reduces infertility. When only one side is affected, fertility is no different from other people, but when both sides are affected, fertility is reduced by up to 50 per cent. These individuals are more likely to develop testicular cancer, so they should have regular check-ups with a doctor so that this complication can be detected early.
Preparation before the operation: educating the patient's family and explaining that, in affected children, the chance of infertility increases with age. This operation must therefore be done and the testes returned to their normal place, because the testis is very sensitive to heat and the temperature inside the abdomen is high compared with the scrotum. If the testis stays inside the abdomen, the cells that make up the testis will be damaged.
If the testis stays inside the abdomen, the cells that make up the testis will be damaged.
Care after the operation
- Keeping the surgical site clean of urine and stool can prevent infection to a large extent.
- If you see signs of infection, see a doctor urgently. These signs are swelling, pain and redness at the operation site, and fever.
- For four weeks after the operation, the child should avoid strenuous activity and play equipment that makes him stand or sit with his legs apart. This is to stop the testes moving out of the scrotum.
- The child should see the doctor again one week after the operation; after that, regular check-ups will be done as needed and as the doctor sees fit, to check how the testis is growing.
Prepared by: Azam Tirafkan – Education Unit
Source: Marlow's Pediatric Nursing
Document code: NO-BR-39