Undescended Testicles

What is an Undescended Testicle?

An undescended testicle, also called a “cryptorchid testis,” is a common event in which one or both of the testes, the male reproductive glands, do not complete normal descent from the abdomen into the scrotum by birth. 

The function of the testicle is to produce hormones and sperm. If the testicle is not in the "correct place," it may not grow, develop or function correctly. Additionally, an undescended testicle may be associated with an increased risk of testicular cancer if not corrected prior to puberty. 

Approximately three out of every 100 full term males are born with a testicle not felt or seen in the scrotal sac, but premature boys have rates closer to 1 out of 3. By the age of 6 months, most of these testicles complete their descent without any interventions. All boys are examined after birth and monitored by their primary care physician.

 

Causes 

The cause for undescended testicles is not fully known, but an increased incidence can be seen with: 

  • Family history (having a father or brother with this condition)
  • Mothers who are older
  • Mothers who suffer from diabetes
  • Boys with low birth weight (less than 2.5 kilograms) or premature birth (before 37 weeks gestation)
  • Down Syndrome
  • Rare anatomic congenital syndromes
  • Rare endocrine conditions

 

Symptoms 

The obvious sign is that one or both testicles are not located in the scrotum. Other abnormalities of the male genitals or urinary tract also may be noted, such as an hernia, hydrocele, or abnormal opening at the end of the penis (called hypospadias). 

The testicle, not in the scrotum at birth, may be: 

  • Near the kidney (where it forms in the fetus)
  • Partially descended
  • Descended to somewhere other than the scrotum 
  • Poorly formed or absent (about 5% of cases)
  • Moving in and out of the scrotum with muscle contractions (retractile testes)

 

Diagnosis

The diagnosis of an undescended testicle is made by a physical examination. Boys who have testicles that have not fully descended into the scrotal sac after 4-6 months of age may benefit from evaluation by a Pediatric Urologist.  

 

Treatment

If the testicle does not descend on its own by 4-6 months of age (premature infants are given more time after birth), treatment is often needed. If left unattended, the undescended testicle will not grow and develop correctly. 

  • Surgery - The surgical correction of an undescended testicle is called an orchidopexy. This procedure is done under a general anesthetic, typically in an ambulatory setting by Dr. Mevorach. Your child will be able to go home the same day. A small incision is made in the inguinal area. The testicle is found, mobilized and placed into a position within the scrotum. A laparoscopic approach is often used, to assist with orchidopexy procedure, when the testicle is not felt prior to surgery. Laparoscopy is also done as a “same day” surgery.

 

  • Late presentation of undescended testicles - Although uncommon, certain children develop the finding of an undescended testicle later in childhood (8-10 years old). While there are certain conditions that have this association (Myotonic Dystrophy, Cerebral Palsy), the condition has also been noted in boys without other medical concerns. Any concerns of testicular position should be brought to your pediatrician or pediatric urologist's attention, regardless of age or prior examinations.

 

  • Hormone therapy - On occasion, especially for bilateral (both sides) undescended testicles, hormonal therapy is considered. The role of hormonal management is complex and related to specific underlying conditions. Hormonal therapy is not beneficial in routine treatment of the testicle that has a question of complete descent.

 

 The Importance of Treatment for an Undescended Testicle

  • The longer the testicle remains outside of your child's scrotum, it is more likely that it will produce fewer sperm, which will impact your son as he reaches childbearing age.
  • There have been studies that show that there is a higher risk of testicular cancer in an undescended testicle. Brining the testicle down into the scrotum makes it easier for a doctor to detect a testicular tumor later in life.
  • An undescended testicle can lead to a hernia or a small opening between the abdomen and the goin. A hernia will require further treatment by a pediatric urologist.