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Undescended testicles
Testicles originate in the abdomen while the fetus is
developing. As the fetus grows, the testes descend into the scrotum. Male infants born at
term should have both testicles descended. Preterm infants often do not have the testicles
fully descended; however, they do so by the time the infant is at the age of when he would
have normally been born.
Many males have what are called retractile testes. This
is a benign condition in which the testes tend to lie high in the scrotum such that the
scrotum may look empty especially when it is cold. Differentiating this condition from
undescended testes is important and done by examination. The child is placed in a warm
room and the doctor's examination is done with the child in a squatting position. The
testes are then manually brought down into the normal position. This should not cause pain
and the testes then may go back to their original high position when let go.
If on examination, the testicle is felt to be simply
retractile, nothing additional is needed to be done, because there is no risk associated
with it. If, on the other hand, it is not retractile or it is difficult to tell the
difference, hormone therapy may help in the diagnosis. Since the 1931, the hormone, Human
Chorionic Gonadotropin (HCG) has been used for diagnosis and treatment of undescended
testes. However, varying dosages have been used on children of varying ages for varying
lengths of time. The result of all this is that it seems the use of HCG in boys with
undescended testicles may work as poorly as one-third of the time. And in fact, up to 20%
of those who do respond to HCG therapy may have the testicle ascend again requiring
further therapy. However, HCG works quite well in children with retractile testes.
Therefore, in cases where the physical examination is difficult, hormone therapy is often
used to distinguish between retractile testes and true undescended testes. Whether hormone
therapy is right for your child depends upon the examination. If the
"undescended" testicle is, in fact, only retractile, neither surgery nor hormone
therapy is required. If the undescended testicle is truly undescended, hormone therapy may
be a consideration but the results may be disappointing. If it is difficult to distinguish
on examination whether the testicle is retractile or truly undescended, then HCG therapy
may be a great option for your child because it may help distinguish between the two.
Because of the possible future risk of infertility and malignancy of the true undescended
testicle, it is advisable to surgically correct at one year of age. So, any hormone
therapy should probably be attempted before then. |
