A concealed testis is a testicle located above the scrotum instead of in it. This is a common problem in about 2% of male infants.
It is vital to recognize the importance of treating this problem early, due to possible ramifications later on, such as the inability to produce normal semen. Likewise, the chances of developing testicular cancer are greater in cases of concealed testicles.
Revealing Undescended Testes
During pregnancy, the fetus’s testicles are in its abdomen and begin to descend into the scrotum during week 28. It is generally thought that the descent is caused by the influence of testosterone, the male hormone.
After birth, if an examination reveals that the testicle is not in the scrotum but in the groin area, there is no need for any intervention. The chances of the testicle moving down into the scrotum by itself within the first six months are high (80%), so regular visits to your family doctor or pediatrician during that time should be enough to monitor the situation.
Testosterone levels in infants are high up to the age of six months, and drop after that. So much so that after six months, chances of the testicle descending independently are almost nil.
If the problem has not been solved by the time the child is six months old, the parents should take their son to a Pediatric Urologist. If the doctor can feel the testis in the scrotum or if it descends into the scrotum during the examination, there is no need for surgery. If the testis is felt in the groin and does not descend during the examination, there will be a need for surgery to put the testis into the scrotum and fix it there.
Delays in this surgery can lead to complications, such as slower development of one testis in comparison to the other one in the scrotum.
As mentioned above, if by the age of six months or more the testicle is still in the groin area, the child should have surgery to bring it down into the scrotum.
The surgery is performed under general anesthetic within a day hospitalization framework. A 2cm incision is made in the groin area and the testicle is detached with the greatest care, while preserving its sperm ducts and blood vessels. It is then brought down into the scrotum. To prevent it returning upwards it is placed and fixed in a little pocket within the scrotum constructed from tissue from the scrotum wall.
At the end of the operation, the incision is sealed using a special glue, which allows for the best cosmetic result. The child can resume normal activity after only a few days. You can wet the area on the day after the operation and remove the plaster/dressing after five days. If the area is red or you see pus-like secretions, report immediately to the ER or the Pediatric Urology Clinic to check for possible infections and consequent treatment.
Undescended Testicle – Special Cases
Testis in the Abdominal Cavity
If at the age of six months the testicle cannot be felt at all in the groin area (during the urologist’s examination), the child should have a laparoscopic examination (micro-invasive surgery). The aim of this is to locate the testicle in the abdominal area. This is done under general anesthetic and the surgeon inserts an optic fiber into the child’s abdomen to scan the area. If the testicle is there, it can be brought down into the scrotum and fixed there, again without regular incision. Surgeons at Shaare Zedek’s Pediatric Urology Department have vast experience in this kind of surgery.
If in the initial examination at the clinic the testicles are found in the groin but can easily be moved down into the scrotum during the examination, this is called Retractable Testis. This condition does not obligate surgery and usually works itself out over time. One can usually suffice with an annual check-up at the Pediatric Urologist to ensure that the testes are indeed moving down. The average age for testicular stabilization and no mobility is age 12-13, the start of puberty.