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What is the treatment for undescended testis? - Online Doctor Chats

Date : 30-Nov-2013
User rating for this question
Very Good Posted in: Testicle Problems
Answered by

General & Family Physician
Practicing since : 2005
Answered : 2408 Questions
User:Hi Doctor
Doctor:How can I help you?
User:Hi Dr. I am looking for urologist
User:but you may help me based on your knowledge
Doctor:I am sorry Mr. XXXXXXX we don't have specialists for chat
Doctor:and yes, I hope I can answer your questions
User:This is a very long text i had typed and kept.Take your time read it and ask if you have any questions and then u can answer me
User:One of my relative has one un-descended testis from birth.All these days he thought he had only a single testis as that was the only one he could feel in his sanctum.He is 30 years old.When he was a child his parents had shown to doctor and they said no treatment is required as the testis will automatically come down in Sac.when he was around 8 years old his parents again showed to doctors as the testis did not come down and again the doctors said it will come down later in life and said no treatment is necessary.Now in last 1 year he felt the presence of another testis in his sac when he sits in stools position.When he stands it is partially down in sac and when he sleeps its completely not felt in sac.So after getting advice to consult a urologist through health magic he got it diagnosed in manipal.So after ultra sound done he came to know some new revelations.The egg shaped mass with identical shape of testis which he thought was his undescended testis was told to him was a inguinal hernia.And the ultrasound doctor said that he has a left testis in inguinal region.The report says following "Realtime UltraSonography of the Scrotum and color dropler study" "Right testis measures 4.9 X 2 X 2.9 cm(Volume 15 cc).Normal in size and echotexture.No focal lesion.No surrounding free fluid.RIght epididymis measures 1 X 0.9 cm. Normal in size, no lession noted.Left scrotal sac is empty.Left testis is seen in the deep inguinal region.It measures 3.7 X 2 X 2.7cm (volume 11CC).There is herniation of omental fat into the left scrotal sac.The defect measures approx 1.8 cm. Impression:Undecended left testis.Left testis in inguinal region.Left inguinal hernia with omentum as its content." Now here are few of my questions: 1.He has no pain as accompanied with hernia.So is any kind of surgery or treatment required? Is this hernia size as in report small or large? I read that if the size of hernia is small then no surgery is required and healthy lifestyle is sufficient.Please advice. 2.Does his left testis which is undescended need to be operated on and brought down into sac at this age of 30.The doctors had said they were no problems seen in testis.So even in case the undescended testis is not fertile does it need to be removed or can it be brought down and kept in sac.? 3.If hernia does not need to be operated on then can undecended testis needs to be operated or its ok to leave it as it is? 4.In case you opt for surgery which of the surgeries do you suggest the best for his case? 5.What is the recovery period(how many days of leave he needs to apply from job and how many days he need to stay in hospital) and what are the pros and cons of the surgery ? When should it be really opted? Only in case of pain? 6.Does all these problems have impact on his sexual life and his ability to have children.He is unmarried so more concerned..? 7.Does congenital hernia(which he is not sure of) can stop the testis from undescending in sac? Any of your suggestions.Please provide a detailed reply for each points.You may ask any question if you have to get more clearity of his situation.
User:do let me know doctor after you have read
Doctor:I have read
Doctor:I am typing out the answer
Doctor:will copy it and send it once done
User:u can send me part by part as well
Doctor:1. Any kind of surgery required?

Yes, absolutely, the surgery should have been performed when your cousin was young and the testis should have been brought down into the scrotum.

This is because, undescended tetsis has a very high risk of developing cancers. Secondly, an undescended tetis can not produce sperms in good quantities.

Size of hernia is not mentioned in the ultrasound report, so I will not be able to comment on that.

It is not exactly the size of hernia that determines surgery, it is the presence of other symptoms that will make it mandotory for undergoing surgery.

A hernia, no matter the size, can become complicated, so it is best to get the appropriate treatment as early as possible.

2. The undescended testis, at this age is generally not brought down, but will be removed completely because of the possibility of cancer.

3. If hernia does not need to be operated, then undescended testis needs to be operated or can it be left as it is?

I have answered this above. Both need to be operated, there is no escape from the surgery.

4.In case you opt for surgery which of the surgeries do you suggest the best for his case?

You will have to ask the surgeon this question, in such a case, if I was the surgeon, I would remove the testis and repair the hernia in a single sitting using a nylon mesh.

It is called mesh hernioplasty.

5.What is the recovery period(how many days of leave he needs to apply from job and how many days he need to stay in hospital) and what are the pros and cons of the surgery ? When should it be really opted? Only in case of pain?

Recovery period generally is about 2 to 3 weeks.

He will have to stay in the hospital for 3 to 5 days.

Pros of the surgery: Preventing a possible cancer in the furture,
Preventing the hernia from getting complicated(Life threatening)

Cons: Like all surgeries, this surgery will have the risk of anesthesia
and risk of recurrence of hernia at a later date
Doctor:I have answered about opting for surgery already, the choice is the patient's own,
I can not decide for you, if you let the testis sit there, then one day it will turn into cancer, so you have to decide you want to take the risk of getting cancer or you want to avoid that risk
Doctor:If the other testis is working well, then removal or undescended testis on one side will not have any significant impact on sexual life.

The congenital hernia is a result of the failure of the testis to descend
Doctor:I have answered all your questions
User:The hernia size is "There is herniation of omental fat into the left scrotal sac.The defect measures approx 1.8 cm." as per report.What and how is mesh hernioplasty done? Are you sure that the undescended testis will eventually lead to cancer ? Is it 100% guarented?Will the hernia grow larger or does it stay the same with time?
User:How much does mesh hernioplasty surgery cost?
Doctor:the defect is different from the size of the hernia
Doctor:defect is referring to the hole through which the hernia is coming out
User:ok doctor
User:Can you answer my above questions
Doctor:The risk of developing cancer in undescended testes is 4 times higher than in normal people
Doctor:we can never be sure about predicting exactly how many percent
Doctor:and about the hernia
Doctor:yes, if left un-treated, the hernia will grow in size
User:I asked you that because the doctors assistant who saw may report was suggesting that we bring it down in sac and later observe if it develops into cancer so i asked
User:so you mean to say if we remove the undescended testis then the other normally decended one wont get affected by cancer?
User:removing the testis stops the cancer from being devloped in other normall testis?
Doctor:The risk for the normal testes is almost as that of other healthy individuals
Doctor:That means, there is no increased risk for the normal testis
User:do you have that stats of in how may cases the undescended testis eventually results into testicle cancer?
Doctor:I already gave you that, we assess the odds ratio or risk ratio
User:How much does mesh hernioplasty surgery cost?
Doctor:so the literature says 4 times higher chance of developing a cancer in the undescended testis than otherwise
Doctor:Mesh hernioplasty cost depends on the surgeon and the type of hospital
Doctor:and the city also
User:in baangalore
Doctor:how can I say
Doctor:if you go to XXXXXXX hospital the surgery cost may be about 10 tousand
Doctor:where as if you go to Appollo or Manipal it may cost you 1 to 2 lakhs
User:DOctor could you please explain what is donw in this surgery..and why would it reoccur?
User:i mean why will hernia grow back even after surgery?
User:in mesh surgery what are the chances of it regrowing
Doctor:first You need to understand how this hernia develops
Doctor:in the case of your cousin, the problem is the undescended testis
Doctor:this leads to a larger than wide opening in the muscles of the abdomen
Doctor:we call that internal inguinal ring and external inguinal ring
Doctor:so when there is an opening in these muscles, the abdominal intestines can get pushed through this opening
Doctor:that is what we call a hernia
Doctor:in mesh hernioplasty the chances of recurrence are low
Doctor:that is why we prefer mesh hernioplasty
Doctor:all other types of herniplasty have higher recurrence rates compared to mesh hernioplasty
Doctor:and the recurrence rates depend on the age, and primary cause for hernia
Doctor:in your case the recurrence rate will be favourable
User:so doctor as i understand hernia can be since birth or developed later.So at the age of 30 can hernia develop by itself he is not sure if hernia happened to him from child birth or developed later
Doctor:Hernia can present in childhood or it can present later
Doctor:There are many types of hernias
Doctor:each has a different type of development and progression
Doctor:some times, even if the defect was present in childhood, since the total are would be much smaller in a child, hernia may not be evident
Doctor:this is what generally happens in undescended testis
Doctor:but it can also develop later on
User:that later on type is at age 30 yrs?
User:or even more?
Doctor:we can not be sure of the age
Doctor:it can happen any time
Doctor:as is the case with all the patients I have seen
Doctor:Hernia can present at any age
Doctor:and as for the recurrence rates, it is very minimal
Doctor:some studies say as low as less than 1 %
User:ok is it guaranteed that the undescended testis is completely non functional or non fertile and cannot produce sperms
Doctor:In medicine we do not use 100% anywhere
Doctor:we do not guarantee anything
User:Since its in abdomal area since birth what are its chances of being normal and furtile?
Doctor:However, it is highly likely that the undescended testis is non functional
User:before we blindly remove it through surgery can we perform some tests to make sure if its functional or not?
Doctor:if you wish to know it is functioning or not, then you should get a biopsy done to see what is going on inside that testis
Doctor:you can get some tests done, a biopsy under anesthesia will tell you if it functioning or not
User:ok so this kind of scan or blood test kind of ting?
Doctor:no, this is a invasive procedure
User:in case if the undescended testes is found to be functional do we still need to remove it or can it be kept
Doctor:means, a doctor will put a needle into the testis and draw out some of the cells from the testis
Doctor:and then those cells will be examined under a microscope to see how they look
Doctor:The choice of keeping or not keeping is yours
Doctor:I have already told you that
Doctor:there is an increased risk of cancer, that is four fold increase
Doctor:so it is up to you, you can keep it
Doctor:or you can choose to get it removed
User:ok so you meant even in case its functional and normal there is a high chance of cancer
User:for undescended testis.
User:ok sorry for confusion i had thought that only if its sterile or non functional it will result in cancer
Doctor:is there anything else you would like to discuss mr XXXX?
User:one last thing
User:what is the treatment for teticle cancer and how much time does one have to get it treated?
Doctor:the best treatment is prevention
User:are there any symptoms for testicle cancer?
Doctor:testicular cancer is generally asymptomatic till late
Doctor:There is nothing like you have any time to get treated for any cancer\
Doctor:the earlier you get treated the better your chances of living
Doctor:what this means is, you will not even know that you have a cancer until it is too late
User:ok so how would one know .any tests?
Doctor:Yes, there are many tests. I would advice you to talk to your surgeon for the type of tests
User:ok doctor thanks a lot for answering my queries..thanks a lot
Doctor:You are welcome
Doctor:Thanks for chatting with me
User:good night same here nice chat and knowledge sharing
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