By Dr Pius Musau
Did you know that all human beings are originally ‘designed’ as females, and the conversion into a man requires adjustments? That what would have been an ovary usually turns into a testis and has to move from within the abdomen into the scrotum?
Well, the truth is, occasionally this descend may go wrong, resulting in a male with one or both testes missing in the scrotum.
This is the most common abnormality in newborn male children with 30 per cent of premature births, three per cent term deliveries and an overall one per cent of the whole population being affected.
A missing testis could be due to failure to develop in the normal manner. An accident in the womb can lead to inadequate blood supply and death of the testis, a developed testis that did not complete the descend into the scrotum or a testis after taking a wrong turn and ending elsewhere other than the scrotum.
Most of the babies born without associated birth defects are found to have no explainable cause of the failure to descend. Some of the reasons to explain the failure include premature birth, twinning, low birth weight, maternal exposure to environmental chemicals like pesticides, use of common pain killers or alcohol during pregnancy, abnormally developed abdominal muscles and as part of a syndrome that affects the normal development of the genitalia.
A father who had an undescended testis has a three per cent chance of fathering a son with the same problem while siblings have six-ten per cent chance among them.
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Physical examination is the mainstay of diagnosing the missing testis. This includes examining newborn after delivery to diagnose the missing testis.
Efforts to use imaging technologies such as ultrasound, CT scans and MRI to locate the missing testis have not been helpful and many specialists discourage it. Where a possibility of the baby being a girl or of mixed gender exists, hormone profiles and chromosomal analysis may be used.
Two thirds may descend spontaneously within the first three months of life beyond which the missing testis can be treated using hormones or surgery. Hormonal therapy has poor results for the truly undescended testis, leaving surgery as the option.
The surgery is best done between the age of 6 and 18 months if it is to restore fertility, avoid psychological trauma to the child and prevent transformation of the testis into cancer later in life.
The writer is a lecturer at Moi University, School of Medicine and a consultant urologist.