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Inguinal testis

The testis develops primarily inside the abdomen. It comes down to the scrotum by birth. The way down to the scrotum is through the inguinal canal. This canal starts from the abdomen by the so called internal opening (internal ring) and ends by the so called external opening (external ring). The testis may stay at any position during its journey of coming down from the neighborhood of the kidney to its final position.

This may be due to a short artery of the testicle or due to a short band (gabernaculum) which fixes the testis to the bottom of the scrotum. A short spermatic string (spermatic cord) may be also responsible for the retention of the testis. The testis may be abdominal, inguinal or even a Penndel testis. Penndel testis means that the testis is wandering between the scrotum and any station upwards.

It is important for the testis to stay permanently or even mostly inside the scrotum. The testis must enjoy a temperature of 1-1,5 C° lower than the temperature of the body to be able to function and not to develop cancer. Inguinal or Penndel testis is subject also to trauma.

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The positions of the testis
1 = abdominal
2 = inside the bar or on the outer ring of the bar
3 = scrotum neck
4 = normal position in the scrotum
H = testicles



Typical position of an inguinal testicle
The testicle is exposed to the following hazards:
1 = Violation
2 = high body temperature



Position of the fixed testes
Testis is fixed to the skin and covered with muscles




Who qualifies for the operation?

Children who are older than one year and who have their testis most of the time upwards.

How does the operation work?

The child is put under general anesthesia on his back. The incision is done in the inguinal region. The testis is delivered outside. The artery, vein and the spermatic string are prepared free and followed as far as their length allows to put the testis to the lowest point of the scrotum. The testis should be fixed without any tension. The peritoneum may be pushed away to reach these structures and free them generously.

The skin of the scrotum is put under tension. A sac is prepared between the skin and the subcutaneous tissues large enough to let the testis be inserted inside it. The testis is pulled with sutures inside this sac without any tension and fixed there. The wounds are closed in layers. A bandage is applied.




Incision




Frequently asked questions (FAQ):

  1. Is it dangerous for the testis to stay in the groin or the abdomen?
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    Yes, The testis must be in a temperature 1,5 °C lower than that of the body to perform its function and not to develop cancer. The abdomen is too warm for it. The groin is easly exposed to trauma and hence the testis.
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  2. When should the operation be done?
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    One year after birth.
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  3. My child has a Penndel testis. Should he become operated too?
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    The indication for the fixation of a Penndel testis is that when it is observed that the testis escapes most of the time upwards.
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  4. What is the danger of  abdominal testis?
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    The development of cancer of the testis and infertility are the most important complications which may result.
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  5. What are the consequences if the testis is fixed to the scrotum later on?
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    They may not develop to a normal size and infertility may be the end result.
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  6. What are the complications of the surgery?
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    The most important three are injury of the testicular artery which supplies the testis with blood. This results in its shrinkage (atrophy). The second hazard is injury to the seminal string which results in obstruction and infertility. The third is the injury of the testis itself so that it must be removed.