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Undescended Testes

Discussion in 'All Categories' started by Nazim - Aug 19th, 2011 6:16 pm.
Nazim	Dear Consultant, I have taken your email address through the website. I am based in London. I am 31 years of age and unfortunately found out that both of my testis are undescended. I have gone through ultrasound and MRI. MRI reports finally told me that both testis are in the pelvis. Now, i want to know what are my chances to bring down testis to scrotum, i have an inguinal hernia developed too. All of my other sexual functions are good, testorone level is good but my sperm counts are zero. Please if you let me know if you have seen similar patients before. I would like to know about every details. Many thanks
re: Undescended Testes by Dr Sadhana - Aug 19th, 2011 6:27 pm #1
Dr Sadhana	Dear Mr. Nazim The primary management of cryptorchidism is minimal access surgery, called laparoscopic orchiopexy. It is usually performed in infancy, but in your case it is too late. Generally if inguinal testes have not descended after 4
re: Undescended Testes by Dr Sadhana - Aug 19th, 2011 6:29 pm #2
Dr Sadhana	Dear Mr. Nazim The primary management of cryptorchidism is minimal access surgery, called laparoscopic orchiopexy. It is usually performed in infancy, but in your case it is too late. Generally if inguinal testes have not descended after 4
re: Undescended Testes by Dr Sadhana - Aug 19th, 2011 6:30 pm #3
Dr Sadhana	Dear Mr. Nazim Surgery is performed often by a pediatric urologist or pediatric surgeon, but in many communities still by a laparoscopic urologist or laparoscopic surgeons. Although many trials have been published, the reported success rates range widely, from roughly 5 to 50percent, probably reflecting the varying criteria for distinguishing retractile testes from low inguinal testes. Some surgeons have reported facilitation of surgery, perhaps by enhancing the size, vascularity, or healing of the tissue. A newer hormonal intervention used in Europe is use of GnRH analogs such as nafarelin or buserelin; the success rates and putative mechanism of action are similar to hCG, but some surgeons have combined the two treatments and reported higher descent rates. Limited evidence suggests that germ cell count is slightly better after hormone treatment; whether this translates into better sperm counts and fertility rates at maturity has not been established. The cost of either type of hormone treatment is less than that of surgery and the chance of complications at appropriate doses is minimal. Nevertheless, despite the potential advantages of a trial of hormonal therapy, many surgeons do not consider the success rates high enough to be worth the trouble since the surgery itself is usually simple and uncomplicated. In your case we may need to remove the testes as due to body temperature it must has atrophied. When the testis is in the abdomen, the first stage of surgery is exploration to locate it, assess its viability, and determine the safest way to maintain or establish the blood supply. Multi-stage surgeries, or auto-transplantation and anastomosis, are more often necessary in these situations. Just as often, intra-abdominal exploration discovers that the testis is non-existent ("vanished"), or dysplastic and not salvageable. We will advice to get one diagnostic laparoscopy done and the strategy of surgical management can be decided according to to position. With regards Sadhana
re: Undescended Testes by Nazim - Aug 20th, 2011 1:39 am #4
Nazim	Dear Sadhna, Thanks for you detailed email. I can confirm few things if it is possible by simply answering your email one by one below:- Although many trials have been published, the reported success rates range widely, from roughly 5 to 50percent, probably reflecting the Nazim : Are you saying that my chances of bringing down the testis are only 5 percent? In your case we may need to remove the testes as due to body temperature it must has atrophied Nazim:- As i have had the detailed MRI and doctor has not reported any problem with my testis, they are perfectly fine. The MRI Report says that both testis are in good conditions but the problem is only they are higher up near the pelivs, just above the inguinal ring. I know the ability to produce sperm is higly unlikely, but still my testis are producing testorone and leveling up other stuff. Therefore I do not want them to be removed completely from my body, Is that something can be done that they will be brought done.? Dose this clear your question when you mentioned "atrophied." Multi-stage surgeries, Nazim: Can you explain me how this will work? Will my age have any side effects on this? What are the success rate with this strategy. Auto-transplantation Nazim: I was reading somewhere that success rate is likely very low with this one, even if there is a successfull operation, the testis fails in 2 or 3 days.? Can you please explain, how this process will be performed by you and what are the success rate with this strategy. Anastomosis Naz: I am not aware with this, can you please explain about it? I look forward to hearing from you. Regards Nazim Zia

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