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Is Surgery Necessary For An Undescended Testicle?
The testes begin to develop in a boy's abdomen near his kidneys whilst he is a fetus. Before he is born they travel down the abdomen, through the groin and into the scrotum or bag behind his penis.
Sometimes they stay in the abdomen or only complete part of the journey, remaining either in his abdomen or in his groin.
Your son's undescended testis and hydrocele may have been detected at his baby check at birth or six weeks. Alternatively, you or your health visitor or doctor may have noticed them later.
A hydrocele is a fluid filled sac which lies within your son's scrotum. It may disappear without any treatment before he is two years old.
It is not dangerous and does not need surgery before the age of two unless the testicle on that side is also undescended.
However, your son's undescended testicle is a different story. In the past there was a tendency to delay operations on undescended testicles until nine or 10 years of age in the hope that the testis might come down of its own accord.
But this may not happen if your son's testis is being held in the wrong place (an ectopic testis) by a band of fibrous tissue which shouldn't be there.
Also, the operation gets harder as your son grows bigger because the distance the testis has to be moved with all its blood vessels becomes greater.
To answer your questions about the future: research has shown that testes need to be in the scrotum to develop normally. Irreversible damage starts occurring in the undescended testicle after the age of three.
After this age there is a risk that his testicle may grow and function less well and in adulthood there is a small increased chance of malignancy. These risks can be avoided by surgery before the age of three.
If your son's testis is truly undescended and can be felt in his groin or high up in his scrotum then the operation is relatively simple. A small incision is made in his scrotum and the testis is brought down and fixed in his scrotum with a couple of stitches which dissolve of their own accord.
Sometimes his testis can be felt in the groin but has lodged in an abnormal site - this is called an ectopic testis as mentioned earlier. It may be held by a fibrous band which will need cutting to release it before it can be put in the right place which will mean an extra incision in his groin.
In almost all undescended testicles and at least half of ectopic testes there is also an inguinal hernia - this is a weakness in the abdominal wall along the same path taken by the testicle through which abdominal contents can bulge.
The hernia may be seen as a swelling is seen in the groin which gets bigger if the child cries or strains but which usually disappears when he is asleep or quiet. The hernia also needs repairing as the abdominal contents can become trapped and block off the bowel and their own blood supply. This is done through a small incision in the groin.
If your son's testicle cannot be felt he may have already had an ultrasound scan to see if it is visible in his abdomen or inguinal canal (the route it would take out of the abdomen).
The surgeon will probably ask your permission for him to make an incision in your son's abdomen should he not be able to reach his testicle through an incision in his groin.
Testicles which lie in the abdomen may need two operations to bring them down, the first one brings the testis as far as possible down through the inguinal canal along the same path as it would have taken in its normal journey.
The second operation performed after one to two years brings it down into the scrotum. Again there may be an inguinal hernia which will also need repairing.
There are the usual risks attached to any operation which are hopefully minimal but include anaesthetic risks and infection or bleeding from the wound site. The future growth, function and fertility of his testis itself is potentially at risk but the outcome is generally very good, certainly much more so than if his testis were left in the wrong place.
As far as I know there is no natural medicine which will bring a truly undescended testicle down into the scrotum. Hydroceles do not usually require treatment under two years of age as many get better.
However, if the surgeon is operating on one side it is likely he may suggest removing the hydrocele on the other side at the same time.
We recommend readers seek personal medical attention in appropriate circumstances.
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After my surgery for testicular cancer, my good friend Joe helped me through my goal of training and running a marathon.
Brian Sluga is now a testicular cancer survivor after receiving the diagnosis when he was 20 years old. Catch up on Brian's blogs here!
It is baffling why we did the things we did. It was easy enough to brush off drama in a small rural town where the unknown is an uncommon occurrence. My 20-something friends had aspirations and everyday opinions about our future with dreams of jobs, marriage and family. I took pleasure in not seeing everything in its finished state. I did pay attention to what my body told me and that's a clue about what was important to me.
I remember my urologist Dr. K providing encouragement after my testicular cancer surgery in my early 20s. I shared with him my desire to keep my running goals. He encouraged me to stick with it. It was then I saw an opportunity to fully be me. I thought, "Why not train for a marathon?"
About 8 months after my testicle removal surgery, I decided to go for it and run a marathon. I read up on training techniques and devised a scheduling system that would enable me to complete my training just in time for the Chicago Marathon.
I needed to eat and sleep much better than I had ever before. So much for those parties and clubs. When the late hours struck on a Friday or Saturday night, the place I would be was asleep in bed. I would never become my own enemy.
After months of running and praying, I was able to set aside fear and go after life a marathon goal would be my start to that new life. My friend since middle school, Joe, helped me train. He would bike alongside or ahead of me as I would run. He kept me going by saying this was only the beginning, and I had much more to accomplish in life.
While training for my post-surgery marathon, I came across a unique training plan: carbohydrate loading. In those days, wisdom was not just what pasta you would eat, but how much you could eat. I thought, "How much pasta is enough to get you through?" After all, 26.2 miles isn't a walk in the park. My buddy Joe is part Italian as I am, so he thought he wanted to get on this training, too. We would frequently get together at a local pizza joint called Vince's. We would put away an extra-large deluxe with two sides of garlic bread. This turned out to be a delicious plan.
Thirteen months after that dreaded surgery, Joe understood my cancer fight. That diagnosis shifted my perspective on life; what my survival and priorities meant. Joe could help me to achieve my marathon goal. It was great that he was a part of my diet and smaller run training, but I asked him to do one more thing. I knew if I could go 20 miles on a training run, I could complete the 26 miles and 365 yards that is a marathon. I wanted Joe to ride alongside me for the full 20 miles. Joe graciously said yes to this three-hour endeavor.
A month before the marathon, I drove out 10 miles of a 20-mile course and marked the spot with white spray paint. I marked the five, 10, 15 and final mile marks. I so looked forward with some anxiety for the early morning run training with Joe. I hoped there would be limited traffic on this hilly, curvy countryside course. Joe understood if I could complete a marathon, I could conquer the fears and anguish I felt daily of losing a testicle.
It wasn't my favorite pair of Nike trainers, a beloved running shirt or even those trusty running shorts, that got me through that 20-mile training run. I had Joe to help me make it through. Through that last marathon training run I could count on entertainment for the duration by Joe, mile after mile.
The first 10 miles were uneventful, with Joe telling stories and giving encouragement as he also huffed and puffed his way through the course. About the 15-mile marker, my legs felt like lead weights and my feet were feeling hot and blistered. I felt the exhaustion of a much different kind. I was completely drained from the August humidity and zapped of mental strength. The muscles in my legs felt used up, and they hurt clear to the bone.
Joe recognized my weak physical and mental state "Come on, come on, Bri. Let's sing!" Joe shouted.
He chose to sing "Lady" by Little River Band. It was a song that reflected on a past love along with feelings in the present. Joe knew I was struggling with dating and relationships because of my cancer. He could always analyze my mood. Perhaps that's why he picked that song to sing. The Little River Band lyrics told a story of the complexities of love. It suggested that one should take the time to be present in a relationship and not let their heart grow cold.
Running was my replacement for expensive therapy. It was how I dealt with my emotions. Sometimes I'd reflect on good thoughts but often painful thoughts of those people in hospitals that didn't have the outcome I did. My entire mind was on a turnaround path while training for that marathon.
Many discover too late their inner critic. We are far too hard on ourselves to discover our true selves. Give yourself a break and let the world know that you are OK when you are and let them know when you need them to bicycle next to you singing. Don't push away people to show strength, rather show strength by letting them in. My zodiac sign is a Cancer, born that way. Cancer is a water sign. I remember when I was about 12 years old, learning it meant I was sensitive, caring and cried a lot.
Thinking back on all those brisk training mornings, it was my first understanding of what it meant to revel in sharing a goal and achieving it. Running can be a lonesome sport where you can either relax or get into your head and be too self-critical. By letting Joe in, he helped me know he understood my situation and pushed me to my full potential. He was part of my goal achievement.
What I can tell you is running, friendship and faith led me where I am today: an athlete, a trusted spouse, a believer in God's healing and still a man who values Joe's advice, counsel and pasta-eating ability.
For more news on cancer updates, research and education, don't forget to subscribe to CURE®'s newsletters here.
What To Know About Mesothelioma Surgery
Doctors perform mesothelioma surgery for various reasons, such as to remove tumors, improve a person's symptoms, and for diagnostic reasons.
Mesothelioma is a cancer that occurs in the thin tissue that lines various organs in the body. Surgery for mesothelioma can be curative or palliative. There are various types of mesothelioma, and the exact procedure depends on what kind a person has.
This article reviews surgery for mesothelioma, including the types of procedures doctors may perform and what it can mean for a person's outlook.
Surgery for mesothelioma can take place for many reasons. It can be curative or palliative.
Curative
If a person with malignant or cancerous mesothelioma is in otherwise good health and the specialist thinks they can completely remove the cancer, they may recommend curative surgery.
During this procedure, the surgeon aims to remove all or most of the cancer. However, in most cases, it is not possible to remove every single cancer cell, which can mean that some cells are left behind. These cells can grow and divide and cause cancer to return sometime after surgery.
For some people, undergoing curative surgery can completely cure mesothelioma. Others may find that curative surgery does not completely cure the disease but does improve their life expectancy.
Palliative
If cancer has spread to other parts of the body, palliative surgery may be an option to enhance a person's life quality by helping reduce symptoms. Palliative surgery does not cure the cancer but is an option for those who are not well enough to undergo more extensive surgery.
Doctors can perform surgery to treat pleural mesothelioma. The main aims of surgery are to relieve cancer symptoms or to confirm the diagnosis when other tests do not provide a clear result.
Surgery is only suitable for a small number of people since it is a major procedure.
What it involves
During the procedure, the surgeon may remove portions or all of the pleura — the membrane that lines the chest and lungs.
Depending on the situation, doctors can perform this surgery by making several small openings in the skin, called keyhole surgery, or by making one large single cut in the chest, known as a thoracotomy.
A factor that healthcare professionals consider is how far the cancer has spread.
If the mesothelioma is advanced, the surgeon may also remove parts of the lung, pericardium, or diaphragm. They will then reconstruct the diaphragm and pericardium using a combination of artificial mesh and natural tissues from other parts of the body.
Benefits and risks
Undergoing surgery for pleural mesothelioma may improve a person's outlook, including life expectancy, and provide symptom relief. Surgery may increase survival by more than 15 months.
Undergoing surgery can also lead to complications, including:
What it involves
During the surgery, a specialist will remove most of the peritoneum — the membrane that covers the abdominal cavity — and the organs nearby where the cancer may have spread. This can include the gallbladder, spleen, or a portion of the bowels.
If the surgeon removes part of the bowels, they will create an opening in the abdomen called a stoma and fit a bag to it to collect the digestive waste. The stoma can be temporary or permanent.
After removing the tumors, the surgeon may administer a heated chemotherapy drug in the person's abdomen. This is known as hyperthermic intraperitoneal chemotherapy (HIPEC), and it can help kill the remaining cancer cells.
Benefits and risks
Undergoing surgery for peritoneal mesothelioma may help improve the outlook and extend the life of a person with this cancer type. Surgery allows for the removal of most of the tumors in the peritoneum before treating the cancer with HIPEC.
Similar to surgery for pleural mesothelioma, surgery for peritoneal mesothelioma may cause several complications, which can include:
Surgery can treat pericardial mesothelioma by removing the pericardium, the sac that protects and surrounds the heart. This procedure is called pericardectomy and can help reduce the pressure on the heart.
In some cases, surgeons may create a hole in the pericardium, called a pericardial window, rather than removing it completely. The pericardial window can also deliver chemotherapy drugs directly to the area surrounding the heart.
If a person has surgery for testicular mesothelioma, surgeons may remove the tunica vaginalis, the layer that covers the testicles. However, this surgery rarely cures testicular mesothelioma as, in most cases, the surgeon cannot entirely remove the mesothelioma.
The life expectancy of people with mesothelioma can vary depending on the stage of their cancer.
The 5-year relative survival rate of people with localized malignant mesothelioma is 24%. However, the more advanced stages of this cancer have a less favorable outlook, with cases of distant mesothelioma having a 7% relative survival rate.
Relative survival rateThe relative survival rate suggests how long someone with a condition may live after their diagnosis compared to someone without the condition of the same race, sex, and age over a specific time. This is different from overall survival rate, which is a percentage of people still alive for a specific time after diagnosis of a condition.
It's most important to remember that figures are estimates, and everyone is different. Talk with your doctor about your specific condition.
However, these statistics do not take into account many factors like:
Undergoing mesothelioma surgery may increase a person's life expectancy. People with malignant pleural mesothelioma who do not receive treatment may die within 4 to 6 months. People who have surgery and receive appropriate treatment can survive between 15 and 18 months.
Surgery can help diagnose mesothelioma and determine the stage and type of cancer. It involves collecting tissue samples directly from the cancerous area — also known as a biopsy.
Doctors may perform laparoscopy or thoracoscopy to collect samples. Both procedures involve inserting a thin tube with a camera either down a person's throat or through a small incision in the side of their chest near the ribs.
If these procedures are not enough to diagnose the cancer, doctors may perform an open surgery. This requires making an incision in the chest or the abdomen to reach the area with the suspected cancer to collect samples and remove tumors.
Surgery can help diagnose, treat, and improve the symptoms of mesothelioma.
While surgery does not usually cure mesothelioma, it can often increase a person's life expectancy. However, as it is a major procedure, only a few people can undergo mesothelioma surgery.
Surgery may not be an option for someone who is not well enough or has advanced mesothelioma.
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