Doctors Lounge - Urology Answers
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Forum Name: Urology Topics
|prhilton - Mon Nov 09, 2009 1:15 pm||
Hello. My son is currently 4 months old and still has an undescended left testicle. I was referred to a pediatric urologist. No doctor has been able to feel the testicle anywhere in the abdomen, so the urologist wants to do surgery. He doesn't want to put my son under anesthesia until he is 6 months old, so the surgery will be in January. He plans to do a laparoscopic examination to find the testicle. If it is there, he will bring it down. If it has formed incorrectly, he will take it out. If it isn't there, then he will be done with the surgery and my son will only have one.
I am very nervous and uncomfortable with the idea of my son being under anesthesia. I spoke with the urologist a few times about my concerns. He is a wonderful doctor and I think I feel as comfortable as possible with him. He said that I would be uncomfortable no matter how old my son is and that my concern is completely normal. He also said that he would like to fix this issue before my son is a year old.
What I would like to know is, does it put my son at any disadvantage if I postpone the surgery until he is older? What kinds of problems can an undescended testicle cause a male? I do not want to harm him by waiting. If you have done this type of surgery on a baby before, how often have you encountered complications from the procedure itself and from the anesthesia?
Thank you for taking the time to address my concerns.
|Dr.M.Aroon kamath - Fri Nov 27, 2009 8:32 am||
Please allow me to explain a few important aspects about testicular maldescent.The undescended testis poses certain problems, notably...
- the risk of testicular cancer
- Risk of torsion of the testicle
- risk of reduction in spermatogenesis and
- risk posed by an associated inguinal hernia.
For undescended testicle discoverd at birth, there is not much controversy about the management.These are treated by orchidopexy between 12-18 months of age (some prefer at 9-12 months of age).The American Academy of Pediatrics recommends surgical correction at one year of age.
In any case, surgery before 6 months of age is not preferred due to the following reasons...
- The blood vessels of the testis are of very thin caliber and thus prone to damage.
- some of the undescended testes(rather low lying) may descend spontaeneously upto 6 months of age.
From the age of 2 years, changes occur in the testis which can be found on light microscopy as well as electron microscopy.
Bringing the testis down into the scrotum before this age can improve semen quality and fertility later in life. Men born with bilateral undescended testes usually have very poor sperm quality, even if corrected by surgery.
Unilateral cryptorchidism has a reported infertility rate of about 10%, compared with about 6% reported for the general population of adult men.The fertility reduction following orchiopexy for bilateral cryptorchidism is more marked, about 38%, or 6 times that of the general population.
As for the anesthetic risk, risk between 6 months of age and 2 years is far less compared to the risks in adults (more the age, more the risk, generally).
I trust this information may be useful to you.
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