Either from what we have been told or from impulse, many parents often check their babies’ toes and fingers and then relax. Kellen Nakachwa just like many others was elated to welcome her baby boy and was content to see he had all his toes and fingers intact.
However, her delight was suddenly turned into alarm when a doctor informed her that her son had an undescended testicle. “I had never heard of such a condition and I was very concerned. But the doctor calmed me down, saying most of them resolve on their own by the sixth month,” she recounts. She was instructed to keep checking on him and to return to hospital if the testicle had not dropped by his sixth month.
According to Dr Anne Wesonga Shikanda, a peadiatric surgeon at Mulago National Referral Hospital, most baby boys will have both testicles in the scrotum at birth. Occasionally, one or both testicles will not have descended within the scrotum at birth. The condition is medically known as cryptorchidism.
“By six months of age, we expect most of these to resolve without medical intervention. However, one per cent will still have undescended testicles that will require surgery,” she reveals.
Dr Shikanda says the cause of this condition is still unknown although several theories exist to explain it.
“The cause is multifactorial and occurs in the first 10 weeks of baby formation in the mother’s womb. In most mothers, the actual cause cannot be identified. Causative factors include errors in the sex differentiation; a process which occurs between the seventh and eight week after conception, hormonal and anatomical factors are also implicated.
If no errors occur the testis should descend from the abdomen to the scrotum week 35 (around eight months), that means both testes should be in the scrotum when the baby is still in the womb,” Dr Shikanda says.
Dr Mary Nyanzi, a peadiatrician at Kampala Hospital, notes that for every 100 full term babies, this condition may occur in three of the babies while for every 100 preterm babies, it may occur in 30 of the babies. The condition does not cause pain to the babies so, it might not be detected until it is too late.
Diagnosis is made during a full physical exam at birth or shortly thereafter. “If a baby is born in the hospital, a newborn check up by a health personnel should identify undescended testis and the mother notified and counselled. Mothers are also encouraged to check their baby’s scrotum to make sure both testes are present,” she says.
The mothers are then advised to follow up with a peadiatric surgeon or a urologist such that surgery is planned at the appropriate time. It is important to note that surgery should not be delayed. By six months of age, if the testis has not moved down to the scrotum on its own, then it will never come down, thus surgery is needed.
For preterm babies, undescended testis is common and most times it descends on its own. The only treatment for this condition is surgery between six months and 18 months of age.
Dr Shikanda reveals that undetected and untreated undescended testis can result in infertility, especially if it affects both testes sides.
Also boys who remain with the condition are at a higher risk of testicular cancer.
These are normal testis that will rise up in the suprascrotal position in the inguinal canal due to the cremasteric reflex. This superficial reflex causes the muscle on the spermatic cord to contract when the boy is cold, anxious, or if the inner thigh is stroked. The testicle is palpable and returns to the normal scrotal position when the child is relaxed. No surgical correction is required.
This is a testicle that descended correctly but was then misdirected beyond the external inguinal ring. In these cases, the testicle is found in other areas.
Incompletely descended testes
The testicle does not descend fully along the tract and therefore can be found intraabdominally, in the inguinal canal or even the external ring:
The testicle is found during the exam in either the prepubic or inguinal canal
During the exam, the testicle is not found, typically located in the abdomen or is absent
Absent or atrophic testes (these account for 3.3 per cent of all cases).