Undescended Testicles
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 a 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)
Diagnosing An Undescended Testicle
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 may 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. Kern. 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, and current guidelines omit hormone therapy for the treatment of typical undescended testes.
Treatment is Important
The longer the testicle remains outside of your child’s scrotum, it is more likely to produce fewer sperm, impacting future fertility. Some studies have shown a higher risk of testicular cancer in an undescended testicle. Bringing the testicle down into the scrotum makes it easier to detect a testicular tumor later on. An undescended testicle can lead to a hernia, which requires further treatment by a pediatric urologist.
At Chesapeake Urology for children, Dr. Adam Kern and the team understands that any health issue with your child is stressful. We will work closely with you in developing a plan of care that best meets your child’s individual needs and are here to answer any questions you may have.