I gave birth to a baby boy one week back. There’s an abnormality in his private parts. One of his testicles is missing. The doctors told that it is not fully grown and after some time it will become normal. Sometimes they may have to do a surgery to fix that. Is it safe to do circumcision (Katna) in this situation?
Your child has a condition called “undescended testis” which means the testis has not reached its final position during the development. It is not uncommon for boys to have absent testis after birth and approximately 3-4% of the boys can have this condition. Chances of having an undescended testis increases if your child is born prematurely, with low birth weight or if the father or brothers of the child had similar condition.
When the child is in mother’s womb, the testes initially grow at a higher location inside his tummy. Then they gradually descend down and by the 6th month of pregnancy the testes would have reached the groin level. At the time of birth normally it would have reached the scrotum. Sometimes, at birth the testes would have failed to reach its final position and still be trapped in the groin or inside his tummy.
More than half of the cases of undescended testes would come down to the scrotum spontaneously in the first few months after birth. If this has not occurred by 3 months, the chances for a spontaneous descent is less likely. In this situation, the child might need a surgery to place the testes in its normal position. Ideally, this surgery should be done by 6-12 months of age in order to preserve the testicular function. In addition to the cosmetic benefit, the surgery is also advised to preserve the fertility function, and to reduce the risk of cancer. Compared to the normal population there is higher risk of testicular cancer in people with undescended testis. Therefore, boys with this condition are advised to perform self-examination regularly after the adolescent age. If there is any suspicion during self-examination, they should be thoroughly examined by a doctor.
A paediatric urologist or a paediatric surgeon can examine your child after 3 months if the testis has not yet descended. Some doctors would request an ultrasound scan to exactly locate the testis in doubtful cases. If the testis is found in the groin or nearby, the child needs a procedure called “inguinal orchidopexy”. This will involve a small incision in the groin and the testis will be brought down to the scrotum and fixed. If the testis is not palpable, they would advise a laparoscopic keyhole surgery which means a camera will be sent inside the tummy through a small whole made in the tummy wall. They would look for the missing testis inside the tummy and would try to bring it down. This might need to be done in two stages depending on the position of the testis. Some children could have been born with an absent testis. In such situations no further action would be required. In some instances, the surgeon might have to remove the undescended testis if they are too small or unable to be brought down to the scrotum.
Approximately one fifth of the boys with undescended testis can have absent testes in both sides. This condition warrants further tests such as chromosomal studies to determine the sex of the child and these children should be seen by a paediatrician soon after the birth.
A child with undescended testis can have circumcision unless they have an associated condition called ‘hypospadias’. In this condition, the child will have an abnormally placed urethral opening and the circumcision is performed only at the time of repairing this abnormality. A qualified doctor to practice circumcision may advise you accordingly if this anomaly is found. Furthermore, circumcision should not be carried out in the event of absent testes on both sides until the sex of the child is determined with further evaluation.
- Abacı, A, G Çatlı, A Anık, and E Böber. 2013. “Epidemiology, classification and management of undescended testes: does medication have value in its treatment?” J Clin Res Pediatr Endocrinol 5 (2): 65-72. doi:10.4274/Jcrpe.883.
- BAPS. 2015. “Commissioning guide: paediatric orchidopexy for undescended testis.” British Association of Paediatric Surgeons. https://www.baus.org.uk/_userfiles/pages/files/Publications/Commissioning%20guide%20for%20orchidopexy%20final%20v7.pdf.
- Cho, A, J Thomas, R Perera, and A, Cherian. 2109. “Undescended testis.” BMJ 364: 1926. doi:10.1136/bmj.l926.