I recently had the opportunity to treat a 14-year-old boy who was only able to feel one of his testes in the scrotum, and this was only intermittent. He presented for evaluation with his mother who admitted that, from his birth, she was never able to feel his testes and was advised by doctors from early infancy to seek medical care. However, she did not.

Undescended testes are not uncommon and should never be ignored by mothers of newborns with this condition.

How common are undescended testes?

This condition is seen in 3.4 per cent of term infants, but in 30 per cent of premature infants.

Why is it that some testes are not within the scrotum at birth?

Both testes develop and grow in the abdominal cavity and later migrate to the scrotum. By about the seventh month in the foetal stage, the testis begins its descent into the scrotum by passing through the inguinal canal. At about the end of the eighth month of development of the foetus, the testis should be within the scrotum.

Descent of the testis is facilitated by hormonal factors, increased pressures within the abdomen normally, development and maturation of various structures outside the testis, and traction by various important ligaments. Failure of these processes to occur or prematurity may lead to one or both testes not being descended into the scrotum.

Why was this 14-year-old able to feel his testis sometimes and not on other occasions?

Some males may have what is referred to as “retractile testes”. A particular muscle within the scrotum, called the cremaster muscle, can sometimes contract and pull the testis up within the inguinal canal or the abdomen. This is actually a reflex that is heightened when a child is frightened or in a cold environment. This is a normal condition but can often be mistaken for an undescended testis.

What are the hazards of having one or both testes undescended?

o Increased risk of developing testicular cancer: 5-10 times more common than normally descended testes;

o Infertility: one of the main roles of the testis is for development and maturation of sperm. In the undescended testes, environments other than the scrotum hinder normal growth and development of sperm. Hence, 50 per cent of males with undescended testes are infertile;

o Associated hernia;

o The undescended testis may easily twist on itself, obstructing the vessels, arteries and veins, associated with the testis. This is called torsion of the testis and is a urological emergency. If the torsion is not corrected, the testis may die.

The mother of the 14-year-old boy was advised that the testes could descend on their own after birth. Is this good advice?

This is correct. In the first year of life, particularly the first three months, most undescended testes will descend spontaneously. This will occur in greater than 70 per cent of term infants and approximately 95 per cent of premature babies. However, mothers should maintain their contact with paediatricians, family doctors or urologists to ensure that infants are re-examined and advice is given about future plans for treatment.

How is the undescended testes brought down if it doesn’t occur spontaneously?

Surgery is the only reliable method to correct an undescended testis. Ultrasound and laparoscopy may be done to determine the location, and then the testes is brought down and fixed in the scrotum, if possible.

My advice to mothers is to examine their male infants for the presence of both testes. If either testis is not felt, mothers should seek medical care. Delays may affect, permanently, the quality of life of their children.

Dr Belinda Morrison is a consultant urologist and lecturer at the University of the West Indies and Mona Institute of Medical Sciences, Mona, Kingston 6. Please send questions and comments to: belinda.morrison02@uwimona.edu.jm