Definition

Ectopic testis or Testicular ectopia is a rare congenital condition in male children. It occurs when the testis does not descend into the scrotum and remains in a location where it should not be. Under normal conditions, the testis descends into the scrotum before and after birth. This descent occurs during pregnancy, following a predetermined route.

Testicular ectopia differs slightly from cryptorchidism or undescended testicles. The pathway for the descent of the testicles into the scrotal sac already exists, and typically, the testicle becomes stuck at one of the descent points. Conversely, in cases of testicular ectopia, the testicle deviates from the normal path and stops at a location within the body. The most common locations for ectopic testicles are the abdominal cavity, pubic or pelvic area, groin, and upper thigh. The position of the testicle is usually abnormal, requiring further examination to locate it. This condition requires prompt treatment due to the risk of serious long-term complications.

This disease is very rare, with approximately 5-10% of cases involving testicles outside the scrotum. It is crucial to recognize testicular ectopia as early as possible because its treatment differs from that of undescended testicles.

Causes

Ectopic testis is one of the genital formation disorders that occur in boys. It is associated with a syndrome called congenital malformation syndrome, characterized by the incomplete formation of fetal organs during pregnancy. The main cause of ectopic testis is still not clearly understood. 

However, there is an opinion suggesting a relationship between endocrine system disorders (the body system that releases hormones to regulate various body functions) during pregnancy and the incidence of ectopic testes in newborns. The recovery rate of ectopic testes depends on the degree of deviation in the position of the testes and the number of testes affected. This condition can occur in one or both testes.

Risk factor

Factors that can increase the risk of ectopic testes in children include:

• Male infants born prematurely
• Male infants with low birth weight
• Presence of genetic abnormalities
• Family history of similar or related conditions associated with undescended testes

Symptoms

The symptoms of ectopic testis are specific enough to distinguish it from similar conditions. The primary sign is the absence of the testes in one or both scrotal sacs. This condition can be immediately noticed at birth as doctors conduct initial examinations to ensure all body parts are present. Undetectable testes can occur in some cases other than ectopic testis, such as retractile testes (testes shifting from the scrotal sac to the groin), undescended testes, or failure of testicular development.

The second symptom is the presence of a lump in another part of the body (besides the scrotum) or even the inability to feel the testes at all. This is a distinguishing feature from other cases. In ectopic testis, the testes are more commonly not palpable. If they are palpable, they are usually in an abnormal position such as in the abdomen or near the groin and upper thigh. Typically, there are no additional symptoms because infants with ectopic testes need to be treated promptly before they reach one year of age.

Diagnosis

The diagnosis of an ectopic testis is established through a doctor's physical examination. Additional tests might be required for confirmation. During newborn checkups, it is essential to examine both scrotums in baby boys to determine the location of the testicles. This examination may be repeated during the baby's first year to verify if the testicles have moved to their correct position.

Additional examinations that the doctor may conduct include ultrasonography (USG). With USG, the doctor can identify an empty scrotal sac and search for the testicles' location along the normal path. The testicles typically appear oval-shaped under the USG machine and may be found in unusual places in the body. In addition to USG, the doctor may recommend magnetic resonance imaging (MRI) to clarify the testicles' location further. Once the diagnosis is confirmed, management measures are usually taken immediately, especially if the child is under 1 year old.

Management

The treatment for an ectopic testis generally involves a surgical procedure to reposition the testis into the scrotum. This procedure, known as orchiopexy, is typically performed by a surgeon or pediatric surgeon. Alternatively, doctors might choose laparoscopic or abdominal surgery to relocate the testicles into the scrotum.

The ectopic testicle is expected to return to its normal position within the first year of life. At the age of 1, the pediatrician will examine the baby to ensure that the testicle has returned to its normal location. If the testicle can be felt along the normal pathway, even if it has not yet descended into the correct position, it is not a cause for concern because the testicle will descend into the scrotum during puberty. However, if the testicle cannot be felt, it may be located deeper, such as in the abdominal cavity.

The optimal timing for surgery varies depending on the location of the testicle and the child's age. Generally, surgery is performed when the child is between 3 to 6 months old but not over 1 year old. After the surgery, the doctor will continue to monitor the child long-term because they are at a higher risk for infertility and malignancies such as cancer.

Complications

Complications of ectopic testis can arise in several aspects, with fertility being a prominent concern as the testicles serve as the site of sperm production. In cases where the testis is not in its normal position and is not properly managed, serious problems may occur in the future. Some potential complications include:

• Fertility issues or potential infertility in the future
• Increased risk of injury or trauma
• Risk of testicular torsion
• Elevated risk of malignancy or cancer

Prevention

There is no effective prevention for ectopic testes since testicular development occurs during pregnancy, and after birth, there is no guarantee that the testes will be in the correct position. However, it is essential to pay attention to health during pregnancy until delivery. Here are some points to remember for prevention:

• Maintain good health during pregnancy
• Consume nutritious foods
• Avoid smoking or drinking alcohol during pregnancy
• Undergo regular check-ups with the doctor, preferably including ultrasound examinations as recommended

When to see a doctor?  

It is crucial to promptly bring your child to the doctor if they exhibit any of the symptoms listed above. An empty scrotum during the first year of life is a warning sign and should prompt immediate medical attention. Discuss future plans with your doctor, especially regarding surgery, to ensure that ectopic testis can be properly and promptly treated.

Looking for more information about other diseases? Click here!