'Lost' testicle


Incidentally, cryptorchidism is also common in male dogs. - Reuters file pix

RECENTLY, I met a chap who is a space and astronomy enthusiast. The gentleman said a rare close encounter of planets Venus and Jupiter would take place today. This phenomenon will not happen again until year 2065.  

Apparently during sunset tonight, in the Western Horizon, we have the privilege to see a rare celestial event and parade of planets. 

Planets Venus and Jupiter will appear so close to each other that they almost seem to touch. 

In addition, the planetary conjunction will also display three other planets, Saturn, Mercury and Mars.  

I was told viewers all over the globe should be able to witness this rare phenomenon even without a telescope.  

This week, we explore a rarity in urology that hardly emerges in adulthood - the issue of a “lost ball”.    

Dear Dr G,  

I am 32 years old and I have a secret.  

All my life, I have only one testicle.

I know this is a bit lopsided, but it has not affected me in any way.  

I have been married for nearly 10 years and enjoy a very healthy life.

My wife and I have an active sex life and we have three amazing children.  

I recently went to see a doctor for abdominal pain and he examined my groin (don't know why he decided to do that?). Now, my secret is out!  

He said he was worried about this and asked me to do a CT scan.  

The scan showed my ball is in fact hiding in my upper groin and is trapped.  

The doctor had asked me to see the urologist and he suggested I should have the ball removed.  

I am reluctant to undergo the operation. I have lived my life without any problem. 

Why should the hidden ball become an issue now?  

Please provide your opinion.

Sam  

In medical term, the lost ball refers to cryptorchidism. The word “Crypto” in Greek means hidden and “orchis” is in fact testicle. This is the absence of one or both testes from the scrotum.  

In paediatric urology, this is a common birth defect in male infants. 

Although 3% of full-term babies and 30% of pre-term infant boys are born with undescended gonad, the vast majority of the testes will descend to the desired location by the first year of life.  

As most of the missing testicles are investigated in childhood, we rarely see adults with cryptorchidism progressing without detection or intervention.  

Strangely, our gonads have their location of origins just below the kidneys. 

The path of descent is determined by pulling forces in the gubernaculum in the scrotal sac, influenced by testosterone.  

A lost testicle is usually tracked along the path of descent, either in the posterior abdominal wall or inguinal canal. 

Some “really lost” balls may even be found in the femoral canal or perineum (that is near the anus, image that!)  

Many men born with cryptorchidism have reduced fertility. 

However, the reduction of sperm count is usually subtle and therefore many men will continue to father children - with or without the surgical intervention.  

Other complications of undescended testicles include torsion and trauma. 

Testicular torsion is the twisting of the spermatic cord resulting in painful infarction of the gonad - this is 10 times more common in undescended testes.  

Besides, the lost location of the testicles in the groin and inguinal canal is also more susceptible to damage from pressure against pubic bone.  

By far, the most feared complication of cryptorchidism is cancer. 

About one in 500 men born with undescended testes develop testicular cancer, which translates to roughly four to 40 folds increased risk.  

The peak incidence occurs in the third and fourth decade of life. The closer the lost testicle is to the body, the higher the risk.  

I have no intention in drawing the similarity between men and dogs, but incidentally, cryptorchidism is also common in male dogs.  

Dogs’ testes usually descend by 10 days of age and overall 10% of male dogs encounter such problem.  

Similarly to men, the risks of trauma, torsion and cancer are significantly higher. 

Therefore, castration of dogs with undescended testes is widely advocated.  

The treatment of cryptorchidism in children is usually orchidopexy, which is a procedure to bring the testes back to its rightful place of the scrotal sac.  

As the condition is rare in adulthood, the removal of the testicle (in other word castration) is instead recommended for an adult with the lost ball. 

The treatment is crucial to reduce the risk of cancer.  

Marguerite de Valois, who is the daughter of King Henry II once said: “The more hidden the venom, the more dangerous it is.”  

In the case of the hidden gonad, the "venom" cannot be ignored. 

In the case of the cryptorchidism in adulthood, removing the “crown jewel” that was never in the scrotal sac will not be badly missed. 


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