By Tedler D. Depaynos, MD
From time to time we have parents who brought their children to the hospital because of a singular testicle. Of course they bathed their children since they were babies and have noticed the defect much earlier but because they thought that the appearance was just delayed their hospital consultations were likewise delayed. Actually in one occasion, the defect was noticed by a surgeon during a circumcision procedure.
The testicles produce millions of sperms but the sperms cannot survive in body temperature. The function of the scrotum is to provide a temperature much lower than that of the body so that the production of the sperms will not be impaired. With non-descent of the testicle, therefore, the testicle cannot produce viable sperms because they are exposed to body temperature. It has to be brought down surgically into the scrotal sac.
During development, the descent of the testicle is thru a tunnel from the abdominal or peritoneal cavity going into the scrotal sac. Normally, this has to close after descent. With non-descent, the closure may also cease where the abdominal contents may instead descend forming the so called inguinal hernia. Hence, undescended testicles may be associated with hernia but we would deal with this in our future columns.
Surgeons sometimes disagree when is the best time to bring down the testicles. Some surgeons argue that it should be done before the child reaches four or even five years of age for best results although others prefer to do it earlier if possible. They say that beyond four years, the testicle would be getting smaller and has a lesser chance of doing its function in producing sperms as well as the “macho” hormone which is testosterone because of the higher body temperature. It starts getting atrophied prematurely just like the testicles of some of our elderly coffee mates. Younger surgeons, however, testify that they have good results even in patients that are about to reach puberty.
Most surgeons with lots of explaining to the parents prefer to bring down the testicle to the scrotum even in older children especially if clinically during surgery the testicle has not yet obviously lessened in size compared to the other one. This is just an attempt to give chance to the testicle to survive with lots of prayers afterwards. If, however, the testicle that was brought down appears to be getting smaller which is better confirmed by follow-up ultrasounds, it has to be excised without second thoughts. It is better to be a little imperfect with a singular testicle than have cancer later on in life that could have been prevented. There is no truth to the belief of some concerned parents that it would make one half manly.
Undescended testicle if left alone has a great tendency to become testicular cancer and one of them is the malignant Seminoma. The chance that it will become eventually malignant in later life in our old textbooks reaches 90%. It is obviously quite high and I am not aware of more recent statistics.
A surgical colleague could recall a patient he encountered who has been working somewhere in Saudi for more than a decade when he started feeling tolerable pain in his right lower abdomen. Because he felt that it was getting worse, he decided to come home for medical reasons. Initially, the impression was Acute Appendecitis but when it was noticed that the patient had a singular testicle and the pain has been present for quite some time a worse impression was entertained. True enough after surgery which was confirmed by the laboratory, the patient had Seminoma.
For individuals with solitary testicles or those who cannot find their other testicle it is best that they undergo a simple ultrasound or better consult your surgeon.
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