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Does this boy have congenital absence of testes?

Q: I have written an article on undescended testes for a leading newspaper. One of the readers having read this article has posed an interesting question in respect of his 27-year-old son who is now works with a MNC. The child born in 1977 appears to have had undescended testes about which the parents were unaware of and totally ignorant until 1990 when he complained of severe abdominal pain. Routine examination revealed that the boy has undescended testes. A CT scan indicates normal study and reports that the testes could not be identified in the abdomen. Surgery was advised, which the grandparents had refused. This was a surprising finding. The child is clinically diagnosed with undescended testes when he was 13 years old. The how can the CT scan say that testes could not be identified. Does it mean that the boy is a case of Anorchia (congenital absence of testes), which is known to be very rare? To substantiate this view do you think that the 27-year-old boy needs to be re-evaluated with a fresh CT scan and relevant investigations to prove our point? The worried parents who were ignorant are now contemplating getting the son married and want to know that which method can bring back the testes? Will any medicines help him? Can he have children?

A:In this country, nothing surprises us any more. So seeing this boy at 27 years is just one of those things. Regarding the specific issues. I presume that both his testes are not palpable. Also, at 27 years, I presume his secondary sex characters are well developed in terms of phallus size and pubic hair. This being so, I can safely conclude that he has functioning testicular tissue somewhere that has been missed on CT scan (this is common). In order to confirm that there is testicular tissue, I would get a serum testosterone, LH and FSH level estimation. This being normal, I would do a diagnostic laparoscopy to locate the testes. At the same sitting, I would bring at least one down into the scrotum. I do hope that he is not harbouring a testicular tumour in the undescended testis.

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