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Undescended testes
. Undescended testes are a common problem. At birth 3.5% of boys will have an undescended testes. Approximately 30% will have both testes involved. A large proportion of these testes will have descended by 3 months after birth with just 1% of boys still having an undescended testes by 1 year of age. Premature infants have a much higher chance of having an undescended testes. Testicular descent is a complex process and not yet fully understood. It is known that the process depends on adequate hormone levels as well as mechanical and neurological factors. Suffice it to say however that the majority of boys with undescended testes will have one side affected only and have no evidence of hormone deficiency. They are otherwise completely healthy and the true cause is unknown. The testes have two important functions. They contains cells that will produce motile sperm once the boy has been through puberty. The second function is to produce sex hormones which are required to bring about the physical changes of puberty and sustain these. Why is it important for the testes to descend into the scrotum? The answer is that the scrotum acts as a cooling device keeping the temperature of the testes 1 to 2 degrees lower than normal body temperature which is essential for the testes to develop normally. Should the testes remain high and buried in the tissue of the groin then development will not proceed normally. Detrimental microscopic changes may be detected by as early 18 months of age. If a testicle remains undescended for several years then the fertility of that testicle may be reduced. If a testicle remains high after puberty then their may also an increased risk of developing growths in that testicle in later years. DorrisWedding wedding party bridesmaid collections in dusty rose

Why perform the operation?

1 To ensure the testes will develop to their full cellular potential and thereby prevent changes that could affect fertility.

2 To prevent any comlications that may arise from an associated hernia that may have the potential to damage the testes.

3 To provide an acceptable cosmetic appearance to the scrotum.

4 To prevent an increased risk of maligancy that may occur in later years if a testicle is left very high.

THE NORMAL MIGRATION OF THE TESTICLE: The testes develop in the abdominal cavity in early fetal life. By 14 to 17 weeks of intrauterine life they migrate to an opening in the body wall known as the inguinal canal. After 28 weeks they pass through the canal and by 35 to 40 weeks reach the scrotum.

The second illustration on the right depicts a testicle sitting off its line of descent lateral to where it emerged from the body wall canal. This is the most common site for an undescended testicle to lodge and is called the superficial inguinal pouch.

The operation to bring an undescended testicle down is usually done as a day stay proceedure and is called an orchidopexy. It is always done under a general anaesthetic. Your child will be allowed home usually 4 to 6 hours after the operation. Two very small incisions are used. One in the skin crease of the affected groin and the other in the scrotal skin. During the operation the testicle is mobilized along with its attached spermatic cord and stitched into the scrotum. Occasionally this process can be achieved through one incision only either a groin or scrotal incision.

POST OPERATIVE CARE

¨1 All dressings remain on for 5 days after which time they can be gently removed.

¨2 The dressings should be kept dry for 3 days after which time the child can then go into the bath.

¨3 All stitches used will automatically dissolve. No stitches need to be removed.

¨ A little swelling and bruising in the affected scrotum is common and will subside over a few days.

¨ Pain relief. Your child will have recieved local anaesthetic into the wounds when asleep during the operation. This provides very affective pain relief for up to 12 hours following surgery. A regular dose of paracetamol by mouth can supplement this. Follow the instructions on the bottle carefully. Most children require only one or two doses. ¨ Follow up appointments are important. Your child will be seen in clinic at 2 weeks and 6 months following surgery. Follow up may be required until your boy has reached puberty.