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Downtown / Main Office
25 Michigan Street NE, Suite 3300
Grand Rapids, MI 49503-2515
CONSTRUCTION Apr. 12 – Aug. 2010
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Allegan Medical Clinic
511 Linn Street
Allegan, MI 49010-1524

Cascade - CT Imaging Center
4070 Lake Drive, Suite L101
Grand Rapids, MI 49546-8294

Greenville United Memorial Clinic
705 S. Greenville West Drive, Suite 202
Greenville, MI 48838-3556

Metro Health Village
2093 Health Drive, Ste 202
Wyoming, MI 49519

The Normal Testicle

The testicle begins to form approximately the second month after conception. By the fourth fetal month, the testicle begins to look like a testicle. At that point in time, it is located in the posterior part of the abdomen near the kidney. It then migrates from that area towards the scrotum. At approximately the seventh fetal month, it begins to pass through a canal (inguinal canal) passing through the abdominal wall. It then continues its journey into the scrotum. We are not entirely sure exactly what triggers and completes this entire journey.

What Is An Undescended Testicle?

The term "undescended testicle" is generally applied to any testicle that is not in its normal scrotal location. This occurs in one of every one hundred boys - a very common problem. There are several conditions that might produce an undescended testicle.

1. The testicle may be absent because it never developed.
2. The testicle may have twisted its blood supply and died before birth.
3. The testicle may still be within the abdominal cavity because it never began its descent.
4. The testicle might lie in the inguinal canal where it became stuck and was unable to continue its passage into the scrotum. This is the most common type of undescended testicle.
5. The testicle may have followed a wrong pathway and ended up in the thigh or behind the scrotum. This is called an ectopic testicle.
6. There are muscular fibers attached to the testicle and pull the testicle up into the inguinal canal when the male is cold or sexually excited or frightened. This is called a retractile testicle. This generally does not require any formal treatment, but, at times, it is difficult to distinguish the retractile (yo-yo) testicle from the truly undescended testicle. We feel that, if the testicle at times lives in the scrotum, then no further hormonal or surgical treatment is necessary. Treatment is only necessary if the testicle cannot be in the scrotum.

Why Is The Testicle In The Scrotum?

It seems to be necessary for the testicle to be located in the scrotum so that the testicle can be 2-3 degrees C cooler than the core body temperature. If the testicle remains in the abdominal body cavity, then the temperature is too high for the testicle to produce sperm.

There is also cosmetic advantage to having both testicles located in the scrotum. This becomes socially important in the locker room. Also, if the testicle is in the scrotum, it can move when it receives trauma, etc. If it is in the inguinal canal, then the testicle may be crushed against the pubic bone if it is accidentally bumped. Another advantage for having the testicle in the scrotum is that it can be checked more easily on physical examination. Testicular cancer is one of the most common solid cancers in men between puberty and 45 years of age. If the testicle cannot be easily examined, the cancer can grow for a longer time before it is detected. If testicular cancer is found early, it is highly curable. We recommend that all men between the ages of puberty and 45 check their testicles at least once a month for abnormal lumps.

Management

If a testicle is not in its normal scrotal location by one year of age, we usually recommend a surgical procedure ("orchiopexy") to place it there. If the testicle is an abnormally formed testicle, not likely to be of use later in life, then it should probably be removed. If it is a relatively healthy testicle, then we make every effort to place it in the scrotum. The procedure is usually an outpatient procedure. It is done under a general anesthetic.

Usually a small hernia-type of incision is made over the inguinal canal. The testicle is found and the connections to the testicle are freed up so that the testicle can be brought down into the scrotum. There is usually a hernia sac that is associated with the testicle, and this must be identified and closed at that time of surgery. The testicle is usually sewn into the scrotum. This is done by making a second small incision in the scrotum.

If the testicle cannot be felt on physical examination, we make an incision higher than usual so that we can explore the abdomen. If we find a good testicle in the abdomen, we try to place it in the scrotum. Sometimes this is not possible in that we cannot gain enough length on the cord. There are special maneuvers that we would try to allow us to place the testicle in the scrotum. Many of the abdominal testicles are not particularly good testicles.

The possible complications of testicular surgery are bleeding and infection. These are possible with any surgery. Transfusions are very unlikely. Infections do not seem to occur very often in children. At times, the testicle may not develop well. Very rarely the testicle may retract back into the inguinal canal and require a second operation to place it in the scrotum.

Fertility

One cannot be certain of the fertility of any male child. We know that many marriages are infertile. We believe that placing the testicle in the scrotum near their first birthday will maximize the chance that that involved testicle will be able to produce good sperm. We, of course, cannot promise that the surgery will produce a fertile male.

Other Considerations

The normal male has two testicles. If one testicle has to be removed because of trauma, cancer, undeveloped testicle, or the developed testicle cannot be placed into the scrotum, the boy will have only one testicle. That one testicle then becomes extremely valuable. We recommend that these children wear a hard cup when they play any contact sports. Serious consideration should be given to having the remaining testicle sewn down in the scrotum to reduce the chance it can twist on itself with a resulting loss of blood supply to the testicle and subsequent death of the remaining testicle.

Undescended testicles have a higher rate of testicular cancer than normally descended testicles. It is not known whether placing the undescended testicle in the scrotum at an early age will reduce the chance of cancer. It is important that the testicle be placed in the scrotum so that examinations are easier. We believe that all males, but especially men with a history of an undescended testicle, should be taught and encouraged to do monthly self-examination from puberty to age 45. If a nodule or hardening is detected, they must contact their physician immediately. Testicular cancer found early is usually very treatable.