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Baby's testicles residing in inner abdomen. Must undergo laproscopic surgery. Affect his adult life?

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Dear Doctor,
My son is around 1 yr 8 months, recently he was diagnosed that his testicles are not in the sack/scrotum neither they have moved down to its place since his birth.
Recently we took him for regular vaccination and expressed about our concern that his sack seems to be very small / flat compared to other kids similar to his age. Then the doctor did the check-up and suggested us to get the scan done.
Post scanning and based on the report - we have been told that his testicles are still residing in inter- abdominal area and he has to undergo laparoscopic surgery (Stephen Fowler treatment) in 2 stages at the earliest.
We are bit paranoid at this moment about the situation and what will be criticality or how complicated it is to get the surgery done for such a small kid.
-     What is the process handled in two stages
-     What surgery he has to undergo in two stages, cant this be done in one go
-     Will there be any complication in the future
-     Can he be a normal man in the future without any problem wrt his fertility, body & sexual life?
-     How much time does it take for him to come out of this situation?
-     Does he need to take any medication even after surgery, if yes how long!
Your advise would be of a great help, request you to provide more details along with the above queries.
At present I am not in India, will there be any complications if we postpone the surgery for next 15 days so that I can stay beside him. OR is this is something even my wife can manage staying with him.
Yours sincerely,
Rajashekar Gavisiddappa
Posted Sun, 27 May 2012 in Child Health
Answered by Dr. Taher Kagalwala 1 hour later
Dear Rajashekhar,

It is very unfortunate that your child's undescended testes have remained undetected till this age. I am very sorry to have to share this with you: the correct position of the testes in the scrotum is critical for the development of germ cells into sperms once the child reaches adolescence/puberty. Intra-abdominal position of the testes can lead to the death of the germ cells and increase the chances of infertility right from the age of a few months. The delay of over 18 months may create fertility related problems in your son, but there is one more reason why the surgery is essential. A testis that remains inside the abdomen at higher body temperatures is at higher risk for development of a genetic mutation leading to cancer of the testis. The risk is slightly high, but a testis that is in the scrotum and freely hanging away from the abdomen is easier to spot if anything abnormal is occurring. An intra-abdominal testis, on the other hand, is equally liable to undergo a malignant change, but the condition is likely to progress more without any obvious symptoms. This may therefore lead to loss of precious time before actual treatment starts for the malignancy.

Coming to the other questions you have posed: if the surgeon removes both the testis (i.e., brings them out of the abdomen and puts them into the scrotum) and if these testes are non-functional, then he may be sterile in later life, but as long as there is no development of malignancy, it would be an acceptable outcome for him, or rather, the best option.

Technically, only a surgeon can tell you the details of the operation, but in general, it is not so challenging as to cause you so much panic. I am sure that if the pediatric surgeon is the one who does the surgery, you have nothing to worry about ... your son will be all right. Also, there is NO harm in waiting for 15 days if you want to be there with him at the time of his surgery.

Lastly, if, God forbid, he is sterile and his testes aren't able to secrete the male hormones normally, he may need life-long replacement of male hormones to be able to have normal sexual abilities like erection etc. This is, as you know, the worst possible outcome. More likely, he may retain SOME sperm formation and modest hormone secretion, but an opinion cannot be formed till the testes are brought out and samples sent for examination.

I hope I haven't confused you totally and my answer is competent enough to give you some direction. Feel free to revert to me if you have more doubts. I also suggest that you seek a professional pediatric surgeon's opinion very soon.

With warm regards and prayers for your son,

Dr. Taher Kagalwala
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