Treat testes issue early to avoid fertility problems

SINGAPORE - Young boys who have an "empty scrotum" are being treated too late, which can affect their fertility when they grow up, a local hospital study has revealed.

The condition, called undescended testis, affects about one in 20 boys, and should ideally be corrected with surgery before the boy is one year old.

But 70 per cent of the 513 boys studied by KK Women's and Children's Hospital between 2007 and 2011 failed to do this.

Instead, they had surgery after they turned one, with a few operated on as late as 10 years and older.

Testes first develop in the abdomen of a male foetus, before they "descend" to the scrotum about eight weeks before birth.

In undescended testis, this does not happen. The boy may end up with only one or none of the testes in the scrotum.

The condition is usually detected with a physical examination. But many boys here had the problem identified relatively late, observed principal investigator Dr Shireen Nah of KKH's paediatric surgery department.

In the study, the average age at which affected boys are referred for surgery is 1.1 years old. Four in 10 are above two years old when they first went under the knife.

"We were quite surprised at the great discrepancy between the recommended operative age and the actual age," said Dr Nah.

The discrepancy is unexpected as there is generally a high standard of health care here, she explained.

The findings were published in November last year in medical journal Archives of Disease in Childhood.

To determine the reasons behind the delay, the hospital is now doing another study to assess the level of knowledge of undescended testis among medical professionals.

Studies abroad have found that the potential to produce sperm drops after one year of age if the testis remains outside the scrotum.

Boys with undescended testis are also eight times more likely to develop testicular cancer.

Surgery, known as orchidopexy, can lower this risk. It can be carried out as a day procedure and require a short recovery time.

Complications, such as bleeding and infection, are rare.

A parent who wanted to be known as Mrs Salleh, 38, said she was very sceptical when the doctor said her son needed surgery after he was diagnosed with the condition at nine months old.

"I was sceptical because he was very young. I thought that the testes would just descend on their own," said the educator, who has two older daughters aged eight and five.

She waited for a few months in the hope that the problem would go away, but it did not.

Her son had corrective surgery several months after his first birthday - past the recommended time frame.

Mrs Salleh had been surprised to learn that the condition, which she had never heard of before, was quite common among young boys.

"Maybe there is a stigma about this topic, so parents do not talk about it. It will be good for parents to be more well-informed," she said.

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