A man who wants to know exactly how things are put together down in his scrotum can find out most easily by sitting in a hot bath and feeling himself. Besides being informative, such a voyage of discovery can help in identifying any abnormality at an early date, assuming of course that one has some knowledge of the anatomy of the scrotum. The surface of a healthy testicle feels smooth, with no irregularities. Distinguishing the testicle itself and the epididymis is fairly simple: the epididymis hangs behind the testicle like a runner bean. At the bottom, where its tail begins the epididymis merges with the seminal duct; this can also be easily located and felt.
The chance that in the course of such a self-examination one will find a lump between one’s thumb and forefinger that according to the textbooks shouldn’t be there, is quite high. However, this should not lead to immediate panic, since in the great majority of cases this is fluid. The best-known forms of this are the spermatocele, filled with a grey liquid which under microscopic examination reveals sperm cells, the hydrocele, filled with pale yellow-coloured clear liquid, and the hematocele, filled with blood.
Undescended testicles
A ridgeling stallion is one in which both testicles have remained at the back of the abdominal cavity and have not descended into the scrotum. Such horses are almost always infertile. With mares, however, he behaves just like a normal stallion, since he still produces normal quantities of testosterone. If the animal is sold as a gelding, the new owner may experience problems, as a ridgeling stallion is inevitably less placid than a gelding. In this way undescended testicles can lead to great confusion and dissension.
In Ancient Rome men with two undescended testicles were not allowed to appear in court as witnesses. Roughly speaking, 20 per cent of cases involved two undescended testicles. The Ancient world did have some notion of surgery, but the range of operations was limited. In fact in those days the choice was between being castrated brutally or with a razor-sharp knife. Moving undescended testicles to their appointed place was impossible. There is little point in treating undescended testicles with medication in the form of hormones and this is scarcely ever done these days. Too often hormones proved ineffective and an operation was subsequently needed anyway.
Over 80 per cent of undescended testicles can be seen or felt in the groin. If they can be neither felt nor seen, doctors speak of cryptoorchidism, meaning literally ‘hidden testicle’. That usually means that the testicle has got stuck somewhere behind the abdominal cavity. These make up some 20 per cent of the total. Tissue examination of undescended testicles shows irreversible abnormalities in the sperm-cell producing tissue from six months after birth onwards. It is therefore crucial to relocate the testicle as soon as possible, that is, in the scrotum. This kind of procedure is called orchidopexy, and in it the testicle is inserted and secured in the scrotum. If the seminal cord is short this can be a particularly awkward operation.
Cryptoorchidism is also found in animals. In cats the abnormality is fairly rare (0.7%), but in dogs it occurs regularly (between 0.8% and її %, depending on the breed). It is most common in small breeds such as poodles, Yorkshire terriers, dachshunds, Chihuahuas, Maltese terriers, toy schnauzers and shelties. Dogs with this abnormality are excluded from breeding. As in humans, if left untreated the sperm quality is anyway exceptionally poor. There are some animals in which cryptoorchidism is normal. In almost all marine mammals, with their streamlined shape, the testicles are located in the abdominal cavity, and the same applies to elephants and hippopotami.
In humans, if the testicle cannot be felt, keyhole surgery is first carried out to check whether the testicle has been formed at all. If the testicle is located high up behind the abdominal cavity, the distance is too great to bring it down together with its stalk. In that case a clamp is put on the stalk, that is, on the artery and vein, after which the blood supply is taken over by the small artery belonging to the seminal duct. This is followed six months later by a second procedure in order to transfer the testicle to the scrotum, a procedure which can also be performed by keyhole surgery.
Being born with a testicle lodged behind the abdomen involves an increased risk of testicular cancer, which is not decreased by timely relocation in the scrotum. In addition it quite frequently happens that no connection is found between such a testicle and the epididymis, which of course means that no sperm cells can be expected from the testicle concerned. It is important in all cases to pinpoint the position of both testicles on the ‘testicular map’ immediately after birth. It is highly improbable that a testicle which has first been located in the scrotum will move to a position behind the abdominal cavity. The ‘testicular map’ is important in the diagnosis of a ‘retractile testicle’. For a short period after birth the previously explained cremaster reflex is not yet present. The reflex goes on increasing until puberty, quite frequently causing boys’ testicles to be pulled into the groin. If there is no ‘testicular map’ and there is doubt whether the diagnosis should be ‘undescended testicle’ or ‘retractile testicle’, it sometimes helps to examine the child while he is lying in a warm bath or squatting.