Undescended testis is a common condition when a testis is arreseted somewhere between abdominal cavity and it’s normal position in scrotum. TYpically it is inguinal canal or suprascrotal location. Sometimes a testis slides inside persistent hernial sac and can be once in prescrotal location and another time in abdominal cavity.
Ectopic tesits is related condition when it rests in place other then it’s normal descend path. This can be suprapubic location, femoral or perineal.
Impalpable testis is broader term concernig a situation, when we can’t find a gonad with palpation or ultrasonography. The final diagnosis is clarified during surgical exploration. It can reveal intraabdominal testis, testicular agenesis or dysgenesis.
Migrating testis is another condition, often mistaken for cryptorchidism. Such testis is in scrotum during emotional and thermal comfort and disappears in inguinal canal when child is uneasy or cold. This situation does not require surgical intervention and resolves during puberty. This patients need yearly follow up – rarelysituation can evolve toward true cryptorchidism.
Undescended testis observed in neonates can improve sponataneously during first year of life, especially in preterm babies. If testis is absent in scrotum after first birthday surgical therapy should be undertaken. This situation in encountered in 1% of male population.
Surgical treatment of all the above conditions is typically done as “one day surgery” – in fact visit at the hostpital should last 3-4 hours. Only patients with haemodynamically relevant heart disease, arrhytmias and neurological disease require one day observation or should be treated at hospital with intensive care unit.
During one anesthesia exploration of inguinal canal should be done and laparoscopic inspection of abdominal cavity should follow if needed. Initially, the inguinal canal should be opened. It brings solution in 80% of patients and requires less invasie anesthesia then laparoscopy.
Outcomes of the opeartion can be:
– fixation of the testis in scrotum – once and forever.
– fixation under tension or at the level of penile base (if more mobilistion is impossible) – after at least 6 months 2nd stage operation is performed
– we confirm absence of viable testis – because of agenesia, atrophia or dysgenesia. We remove any remnants if present and we should fix the other testis (preventing it’s possible torsion).
Post-oprative days are not very difficult – for 1 or 2 days paracetamol may be needed – depending to some extendon child’s emotional attitude. We suggest 3 days of rest. The dressings are removed by parents on 5th postoperative day, we propose control visit on day 7-10, and then after 4 months, when we can evaluate final result.
Information for parents about undescended testis can be found on official webpage of European Society of Pediatric Urology here