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Undescended Testis

Dr M Zahid Hasan

Many a times we get patients of different ages with one testis in scrotum and the other one in inguinal canal or inside abdomen. Recently one young man, a soon-to-be bridegroom, came to me with only one testis in his scrotum, for correction of his anomaly. Common questions in this regards are:

Where is the other testis?

Can we bring it down into scrotum if remain inside?

Will it produce sperm or can he be father?

Can he be able to perform sex?

Can he develop testis cancer if it remains inside?

What if he does nothing and proceeds for marriage since there will be future attempt for having children?

As we are aware that testis develops inside abdomen of the unborn fetus along with Kidneys and gradually come down outside the body into scrotum before the baby is born, sometimes this may not happen and testis may remain anywhere in its path up to scrotum. If it remains near root of penis there is small chance it may descend further in to scrotum within 6 months of age of the baby. This condition is called  Undescended Testis or Cryptorchidism.

Testis has two main functions: 1) Sperm production 2) Hormone (Testosterone) production

Inside scrotum temperature is 1 or 2 degree Celsius below body temperature. If testis remains anywhere other than scrotum, higher body temperature will eventually destroy all spermatogonium (stem cell for sperm) within one year of age of the baby though hormone production will remain intact. Furthermore at body temperature Germ cells in testis shows cancerous changes which might lead to increased chance of Testicular Tumor development in undescended testis.

For efficient reproduction and sexual performance, one testis with good blood supply and patent sperm pathway rightly placed into the scrotum is adequate.

After evaluation the above mentioned patient showed normal right testis, left hemi scrotum was empty and USG showed left testis located in pelvic cavity just behind the deep inguinal ring. Semen analysis and serum testosterone level were found within normal range.

We recommended an Operation (Orchidopexy) to bring down the left testis into the scrotum or at least in the inguinal canal to be palpable under the skin so that he himself can feel any change (cancerous) in that testis early, should it happen at any time. This testis will not produce any sperm but will continue to produce testosterone hormone.

Newly born male babies with undescended testis must go under Orchidopexy surgery before his first birthday to have an ensured healthy sexual reproductive adult life.

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