UNDESCENDED TESTIS IN AWARENESS-POOR SUB-REGION BY DR
OSARUNWENSE DAVID OSIFO.
Consultant Paediatric Surgeon, Paediatric Surgery Unit, UBTH, Benin City. Seminar
presented on 4th October, 2012 in Institute of Child Health, University of Benin, Benin
City, Edo state, Nigeria.
INTRODUCTION
During the Institute of Child Health monthly seminar for the month of September 2012 Dr
David Osifo a consultant paediatric surgeon of the department of Paediatric surgery,
University of Benin Teaching Hospital, Benin City discussed the problem of undescended
testis. He noted that complications often result due to late presentation among Nigeria
patients. This late presentation he believed was due to lack of awareness.
He started the presentation by showing pictures of normal scrotum (figure i) and then pictures
of abnormal scrotal sacs. He defined cryptorchid scrotum as meaning hidden testes. This he
said may include retractile testes 60.0% of cases, undescended testes 35.0%, ectopic testes
3.0% and ascending in <2.0% cases. The retractile testes is common in adolescents and is
usually due to testosterone perhaps due to cold, fear, pain, etc; and sometimes regarded as
'welcome back testes'. Ectopic testes can be found in different parts of the body -inguinal
region, abdomen, peritoneum, etc.
EMBRYOGENESIS
By 8th week of intra-uterine life, the testis is already formed. However due to changes in
temperature, the testes migrate from the flanks where it is formed to the scrotum. Fully
formed testes function at temperature 3 - 4°C less than the normal body temperature.
Continuous exposure to core body temperature has deleterious effect on the testis. The
scrotum forms as the shutter window. The descent of the testes occurs in two distinct ways:
(a). Intra-abdominal (mechanical) phase- 8 - 1 5 week of gestation (b). Inguinoscrotal phase28 - 35 weeks (hormonal phase). Hormones which include the androgen-calcitonin gene
related peptide, and androgen play key roles in that the testes tend to migrate towards areas
where there is high concentration of this hormone. Factors which affect intra- abdominal
pressures such as in anterior abdominal wall defects as seen in omphalocele, gastroschisis,
prune belly syndrome, extrophy of the bladder, etc affect the descent of the testes resulting in
undescended testes.
The time table for testicular descent according to Dr Osifo is 8th week-formation
12th week: Iliac fossa
15th week: close to the deep inguinal ring 28th
week: burrows through the deep inguinal ring 32
week: emerges from the superficial inguinal ring
35 -40th week: descends into the scrotum.
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There is post natal testicular descent. 4.0% of all males at birth will have undescended testes.
This reduces by 1.0% at 1st birthday. In a study published by Dr Osifo and his colleagues in
20091 it was observed that 178/6180(34.9%) infants had fully descended by 7th month of post
natal life. About 20.8% of those with undescended testes developed complications between
the agel2 and 24 months. The conclusion from this study was to follow-up all undescended
testes for 7 months and thereafter all undescended testes should be brought to the scrotum by
surgery to avoid irreversible damage to the testes.
COMPLICATION OF UNDESCENDED TESTES
Dr Osifo noted that almost all complications of undescended testes are preventable.
Complications usually result from the effect of the higher intra-abdominal temperatures on the
testes which require lower temperatures to function effectively. The effect of undescended testes
on the Endocrine function of the testes is usually irreversible. Other complications are reduced germ
cell development located in the seminiferous tubules, infertility due to azospermia;
malignancy (commonly a seminoma). Inguinal hernia (hernias associated with undescended
testes), torsion of a crytorchid testes, trauma, recurrent epididymorchitis, micro-trauma which
may damage the testes before the age of 4 years, psychological complications resulting from
impotence may also occur.
MANAGEMENT
Dr Osifo stated that early presentation is very important. Late presentation when
complications have occurred can be deleterious to health.
Management entails adequate history. Every male is entitled to have two testes in the scrotum.
Refer to the specialist if there is only one or no testes in the scrotal sac. Ask for groin
swelling, acute pain in the groin and through physical examination should be done.
Treatment should be instituted between ages 6 months to 2 years. Surgery is the main stay
treatment and involves bringing the undescended testes into the scrotum and fixing it there.
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