Monday, May 10, 2010

Testes of Infant Not Found in Place

My pharmacist came rushing to my room with a worried look, saying that the testes of his 15 days old grandson are not found in place. His daughter was living in Mumbai. I thought the baby must have been examined by the pediatrician after birth and must have been alerted then. I just suggested to palpate the testes a little up in the groin towards abdomen and advised to consult a doctor, if not found. After two to three days he informed that those are found.Many times testes are retracted towards abdomen, especially in infants, remain hidden in the lower abdominal wall. Sometimes of course, they are not found externally. The condition may be undescended testis, usually seen in one side, more so in the right; if does not descend from abdomen, where it normally develops while in mother’s womb. It may be called imperfectly descended, if it goes to some other place than the normal place.

The position of testis can be determined by ultrasonography. Most of the time, infants have retractile testis, as in this case due to strong pull of muscles and does not pose any problem. If truly, undescended it requires action. A patient can be watched ordinarily for two years, during which time it may descend down to the scrotum without any intervention, and is without any consequence. If it does not, has to be brought out by surgery. An undescended testis does not develop fully in an environment of raised temperature inside the abdomen, and may become incapable of producing sperm leading to infertility. Sometimes, it may undergo malignant transformation. An undescended testis after age of 14 years has to be removed and examined by pathologist. Before this age, it may be brought out and kept.
Seminoma, a type of cancer of testis is common in undescended and intra-abdominal testis.
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