Treatment of Undescended and Retractile Testicle

Treatment of Undescended and Retractile Testicle

When it comes to the reproductive system issues in male children, the proper development and normal positioning of the testicles are crucial to fertility and overall health. Two conditions that may affect the testicles, often confused with one another, are retractile and undescended testicles. Although they both relate to the testicle’s location, their causes, effects, and treatment are vastly different. Thanks to Dr. Enmar Mohamed Habib, Professor of Urology and Pediatric Urology at Cairo University and Fellow of McGill University, Canada, children can receive appropriate treatment through early diagnosis and effective control of any health concerns.

What are undescended and retractile testicles?

1. Undescended testicle: During fetal development, the cells that form the testicle and kidney develop in the abdominal pelvis. The kidneys move upward, and the testicle moves toward the outside of the abdomen through an opening in the abdominal muscles. Just before birth, the testicles hang from the inside of the abdomen into the scrotum (a bag of thin skin that contains the testicles). An undescended testicle occurs when one or both testicles fail to descend into the scrotum before or after birth. An undescended testicle is usually discovered during a postpartum examination or a routine checkup at six to eight weeks. An undescended testicle can be located anywhere between the abdomen and the inguinal canal area, such as the neck of the scrotum, in front of the abdominal wall, or within the abdominal wall.
2. Retractile testicle: A retractile testicle descends after birth into the scrotum but can easily move backward (retract) into the inguinal canal as a reflex response to stimulation (e.g., heat, touch, fear). This condition is caused by a strong or overactive muscular reaction from the cremaster muscle, which involuntarily pulls the testicle from the scrotum by contracting. A retractile testicle often moves down into the scrotum on its own, but it may need to be moved by hand without pain.

What are the symptoms of undescended and retractile testicles?

1. Undescended testicle: One or both testicles appear missing or cannot be felt in the scrotum of the affected child. If both testicles are undescended, the scrotum will appear unusually small and flat. If only one testicle is affected, the scrotum may appear asymmetrical. An undescended testicle does not cause any pain to the affected child, but should be carefully monitored after birth.
2. Retractile testicle: In the case of a retractile testicle, one or both testicles sometimes appear to be present in the scrotum and sometimes not. This condition typically does not require any treatment.

How are undescended and retractile testicles diagnosed?

1. The diagnosis is made by a pediatrician in the first few weeks after birth. The entire genitals are examined, and the doctor tries to locate the testicle if it is not in the scrotum. If it cannot be felt, the child is referred to the best urologist, Dr. Enmar Mohamed Habib, for a more thorough examination and accurate diagnosis.
2. If the scrotum is empty, Dr. Enmar Mohamed Habib first determines the location of the testicle to decide the appropriate treatment by attempting to bring the testicle down. If the testicle can be fully inserted into the scrotum and stabilized, there is no need for surgery. However, if the testicle cannot be brought down by hand or not felt, it is an undescended testicle and requires surgery and appropriate treatment.
3. Additional tests may also be required if the testicle cannot be felt, such as blood tests and other examinations, to determine whether the child has a condition that affects the normal development of the reproductive organs.

Complications of undescended testicle:

Without treatment, an undescended testicle can lead to serious complications. Therefore, it is essential to follow up regularly with Dr. Enmar Mohamed Habib to receive proper treatment and avoid any potential issues resulting from an undescended testicle. Some complications of neglecting undescended testicle treatment include:
• Hypogonadism: For the testicle to play its role in producing male hormones and sperm, it must be at an appropriate temperature outside the body (about three to five degrees below body temperature). Therefore, the presence of an undescended testicle inside the abdomen affects its function. An untreated undescended testicle affects fertility, especially if both testicles are undescended. This occurs due to reduced testosterone production, which affects sperm production and causes infertility. It also affects the onset of puberty.
• Testicular cancer: Although rare, testicular cells within the abdominal wall can become cancerous over time. If not treated in time, it may require surgical removal.

Treatment of undescended and retractile testicles:

Treatment methods vary depending on the testicle location. With the expertise and skill of Dr. Enmar Mohamed Habib, he determines the right treatment for each case, ensuring that the child receives the best care and attention. Treatment is determined based on the following:

If the testicle is located at the neck of the scrotum or higher than its normal position outside the abdominal wall:

• The affected child is likely to be monitored periodically until 9 months of age. In some cases, it may only be necessary to wait until the testicle reaches an appropriate size to allow it to descend normally into the scrotum. 
• Hormone treatment may also be given to the child to increase the size of the testicle, which improves the chance of its descend into the scrotum.
• If the child reaches the age of one year and the testicle fails to descend into the scrotum after hormone therapy, surgery is recommended. The surgery involves making an incision to help the testicle move to its proper location and then stabilizing it in the scrotum after placing it in its natural position. The child will often need hormonal treatment after the procedure to stimulate the testicular cells to produce sperm normally.

In the case of an undescended testicle within the abdominal wall:

An undescended testicle inside the abdominal wall is treated surgically without waiting for the child to reach 9 months of age. With the expertise and skill of Dr. Enmar Mohamed Habib, the condition is effectively treated using a laparoscopic procedure. The procedure helps locate the testicle and allows Dr. Enmar Mohamed Habib to place it in its natural position inside the scrotum and stabilize it there.

In the case of a retractile testicle:

The testicles usually stop retracting into the groin area at puberty because they have grown larger. Therefore, a retractile testicle does not require surgery or other treatment. However, if it does not descend, hormonal therapy or surgery is used to stabilize it within the scrotum.

Does surgical treatment for undescended testicles affect the child's future fertility?

Surgery does not affect a child's fertility, especially in boys with a single undescended testicle. Boys who have the condition can have children in adulthood at the same rate as boys who do not have the condition at all. In the case of bilateral undescended testicles, the risk of future infertility increases if the surgery is neglected.

In the end, parents are confused and frightened when they find out that their child has testicular issues. However, it is important to remember that treatment is always available effectively, safely, and with the latest treatment methods. The expertise of Dr. Enmar Mohamed Habib, Professor of Urology and Pediatric Urology at Cairo University and Fellow of McGill University, Canada, who specializes in treating children and adults, ensures that your child receives the highest level of care. Don't hesitate to get your consultation now.