By Rev (Prof) David Osifo
In part one of this lecture we discussed VARICOCELE in which testicular veins failed and consequently unable to remove deoxygenated blood from the testis. This results in dilated tortuous testicular veins filled with deoxygenated blood and waste products that are poisonous to the testes thereby resulting in low sperm count and infertility. It was said to be the commonest cause of male infertility followed by undescended testis which is the topic of this part 2.
WHAT IS UNDESCENDED TESTES?
It is the failure of the testes to descend into the scrotum before the child is born.
Every male child has two testes, one in each hemiscrotum. They are formed in the abdomen but descend into the scrotum just before the child is born. They descend into the scrotum that is a cooler environment, and out of the abdomen because they cannot tolerate the hotter interior environment of the abdomen. Failure of one or both testes to descend out of the abdomen gradually leads to irreversible complications in the testes, including the one that had descended properly. If one testis is undescended, anything that happens to that one which is undescended will also eventually happen to the one that had properly descended, a phenomenon called testicular sympathy. That is why urgent attention is given, otherwise the child may end up having no viable testis before the age of marriage. The attached picture shows a baby whose right testis (to your left in the picture) failed to descend before birth. If the testis is undescended operation called orchidopexy is urgently done before the child is two years old.
If operation is not done before 2 yrs to bring out the testis the following complications can happen:
1. Injury to the undescended testis at play
2. Development of cancer of the testis before adulthood.
3. Repeated infection of the testis which will render it incapable of producing sperm in adulthood.
4. Torsion of the testis which will make the testis to twist on its blood vessels and die before adulthood.
5. Gradual reduction in the size of the testis so that by adulthood there is no living cells in the testis required to produce sperm.
6. Infertility when the child finally get married
7. Inferiority complex when the child grows up and finds out that he has no testes in the scrotum unlike his peers.
8. Suicide attempts and tendency towards criminalities.
Unfortunately most of these complications of undescended testis are painless and the unsuspecting parents and caregivers may not be aware of them until it is too late. There is nothing any doctor can do when irreversible complications have occurred, hence the need for early presentation of the affected child.
What to do as parents and caregivers:
1. Take time to check the scrotum of a male child. Touch it and feel for two small seeds (testes) inside. If the child has grown up and may not allow you to check his scrotum then wait until he falls asleep at night and carefully check it.
2. If there are no two testes in the scrotum kindly present him to a doctor who will refer him to experts to operate on him.
3. Remember that the 8 complications listed above start from two years, so hurry and don’t allow anyone convince you that it will come out in future. Many parents have complained bitterly that a health worker told them to wait and that the testes will come out on their own with age. That is very misleading.
4. If the child has been operated and the testis is successfully brought out, keep an eye on him and take him to see the doctor once in a while until he gets married. He may be required to do sperm count after he attains puberty to be very sure he is fertile.
5. A child who had undescended testis that was brought out should be encouraged to get married as early as possible. Remember that the testis was brought out by man and not God. He is therefore not a candidate for delayed marriage.
God bless you all.
Note: Professor David Osifo is of the University of Benin/University of Benin Teaching Hospital (UNIBEN/UBTH).
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