Undescended Testes (Cryptorchidism)

Causes of Undescended Testes

When a baby boy is developing in utero, the testicles form in the abdomen. Around seven months of gestation, the testicles should move down into the scrotum. When a testicle is undescended, it doesn’t complete this process. It may be located anywhere in the abdomen or groin region. Causes of undescended testes are unknown and may include:

• Prematurity
• Abnormal anatomy
• Hormonal problems
• Environmental factors
• Spina bifida
• Inguinal hernia

Risk factors for undescended include:

• Small for gestational age
• Born before 36 weeks gestation
• Low birth weight
• Have a family member with the condition

Symptoms of Undescended Testes

The most common symptom of undescended testes is when one or both of a baby’s testicles cannot be felt inside the scrotum during an exam. If only one testicle is undescended, the scrotum may appear lopsided; if both are undescended, the scrotum may look flat or smaller than usual. If this occurs, a variation of sex development should be ruled out. A baby’s testicles may appear to be there sometimes and missing at other times. However, during a physical examination it is possible to bring them into the scrotum, where they remain for some time. This is known as retractile testicles and does not need to be treated.

Potential Complications and Risks of Undescended Testes

Problems associated with undescended testicles include:

• Increased risk of infertility: When the testicles are undescended, the warmer body temperature inside the abdomen or groin may impede testicle development. This could affect the development of healthy sperm later in life.
• Higher risk of testicular cancer: Even after surgery, males with undescended testicles are at a slightly higher risk for testicular cancer by age 30 – 40. However, corrective surgery will allow for testicular self-exams so that abnormalities can be caught earlier.
• Inguinal hernia: When part of the intestines pushes through the abdominal wall.
• Testicular torsion: Though rare, this painful twisting of the testes can decrease blood supply and lead to permanent damage or loss of the testicle.

Undescended Testes Diagnosis

Your child’s pediatrician will examine the testicles during regular well-child visits. If they do not feel the testicles in the scrotum, they will try to locate them within the abdomen or groin. Your child may also be referred to a pediatric urologist for further evaluation.

Your child’s doctor will try to rule out retractile testicles by trying to move the testicles down into the scrotum. If this can be done, no further treatment is required. If not, your child may determine that they have undescended testes.

Undescended Testes Treatment

In some cases, the testes will descend into the scrotum on their own, often within the first 3 – 6 months of life. However, if they do not descend, surgery may be required.

The procedure to move the testes into the scrotal sac is called orchiopexy. This procedure is often enough to correct the issue. During an orchiopexy, the surgeon will free the testicle from its location in the groin area through a small incision and bring it down into the scrotum. Children can often go home the same day or the next day after the procedure.

If the teste is impalpable (not able to be felt during a physical exam), a laparoscopic procedure is done first and the orchidopexy will be completed in two stages 6 – 9 months apart.

Orchiopexyis highly recommended to reduce future infertility and cancer risks and other long-term effects, as well as to improve your child’s body-image during adolescence.