Undescended Testes

(Cryptorchidism)
Pronounced: kript-or-kid-ISM
by Nathalie Smith, MSN, RN
En Espaol (Spanish Version)

Definition
Under normal circumstances, the developing testes of a fetus grow within the abdomen. Just prior to birth, the
testicles move downward through the inguinal canal and into the scrotum. In the cases of undescended testes, the
testicles stay within the abdomen, even after birth.
Undescended Testis

2011 Nucleus Medical Media, Inc.

Causes
Undescended testes are a congenital problem, meaning they are present at birth. The exact cause is not known, but
inheritance may play a role. There may be some hormonal abnormality associated with the development of
undescended testes. Twisting (torsion) of the testes within the abdomen during fetal development may cause injury
or loss of the testes. Ascending undescended testes may occur in boys during childhood when a previously
descended testis moves out of the scrotum into a low inguinal position.

Risk Factors
The following factors increase your childs chance of having undescended testes. If he has any of these risk
factors, tell your doctor:
Prematurity
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Low birth weight

Twin gestation
Down syndrome (fetus) or other chromosomal abnormality
Gestational diabetes mellitus
Prenatal alcohol exposure
Hormonal abnormalities (fetus)
Toxic exposures in the mother
Mother younger than 20
A family history of undescended testes

Symptoms
Undescended testes cause no symptoms. They can, however, become twisted inside the abdomen (a
condition called testicular torsion), a problem that requires surgery.
Grown men with undescended testes may have low sperm counts resulting in infertility, and are at increased
risk for hernia and testicular cancer because of their untreated undescended testes.
Increased risk of hernia
Increased risk of testicular cancer, even after surgical correction, and even in the other, properly descended
testicle
In a similar condition called retractile testes (also known as hypermobile testes), descended testes slip
easily back and forth between the scrotum and the abdomen. Retractile testes do not lead to cancer or other
complications. They usually stop retracting by puberty and do not require surgery or other treatment.

Diagnosis
Your doctor will ask about your symptoms and medical history, and perform a physical examination. A diagnosis
of undescended testes is usually made by a pediatrician based on the fact is one or both of the childs testes cannot
be felt within his scrotum. Additional tests may include the following:
Radiographic imaging MRI and CT have been shown to be more accurate than ultrasound in identifying
intra-abdominal testes.
Laparoscopy a surgical procedure using a tiny video camera inserted within a small keyhole incision in
the scrotum. This can identify the presence of a testicle within the abdomen, and can potentially then be used
as treatment, as well.

Treatment
Talk with your doctor about the best treatment plan for your child. Treatment options include:
Giving the problem time to go away on its ownIn most children, this happens by four months of age,
without any other intervention.
Hormone therapy using human chorionic gonadotropin (HCG) is used infrequently.
If the testes do not descend on their own, the problem can be repaired by a surgery called an orchiopexy.
This is done while your child is asleep under anesthesia. The surgery may be performed through a traditional
open incision, or through keyhole laparoscopic surgery

Prevention
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There is no known way to prevent undescended testes. Preventable complications of undescended testes may
occur, however, as your child grows and matures. These include:
Infertility or testicular cancer in adulthood.
Injury to the undescended testes.
Emotional stressWhile surgery usually results in a normal appearing scrotum, the undescended testis is
sometimes smaller than the normal one. If your son becomes concerned about this as an older child or
adolescent, a prosthesis (artificial replacement) can be placed in the scrotum.
RESOURCES:

American Association of Pediatrics

http://www.aap.org/
National Infertility Association
http://www.resolve.org/
CANADIAN RESOURCES:

Health Canada
http://www.hc-sc.gc.ca/index_e.html/
Infertility Awareness Association of Canada
http://www.iaac.ca/en/home/
REFERENCES:

Ferri FF. Ferri's Clinical Advisor: Instant Diagnosis and Treatment . 8th ed. Edinburgh, England: Elsevier Mosby;
2006.
Kleigman R, Behrman R, Jenson H, Stanton B. Nelson Textbook of Pediatrics . 18th ed. Philadelphia PA:
Saunders; 2007.
Kolon TF, Patel RP, Huff DS. Cryptorchidism: diagnosis, treatment, and long-term prognosis. Urol Clin North Am
. 2004;31:469.
Leung AK, Robson WL. Current status of cryptorchidism. Adv Pediatr . 2004;51:351-377.
MS Jensen, JP Bonde, J Olsen. Prenatal alcohol exposure and cryptorchidism. Acta Paediatr. 2007;96:1681.
Patil KK, Green JS, Duffy PG. Laparoscopy for impalpable testes. BJU Int . 2005;95:704.
Thonneau P, Candia P, Mieusset R. Cryptorchidism: Incidence, risk factors, and potential role of environment. J
Androl. 2003;24:155.
Trussell JC, Lee PA. The relationship of cryptorchidism to fertility. Curr Urol Rep . 2004;5:142.
Virtanen HE, Tapanainen AE, Kaleva MM, et al. Mild Gestational Diabetes as a Risk Factor for Congenital
Cryptorchidism. J Clin Endocrinology & Metabolism. 2006;91:4862.

Last reviewed September 2011 by Adrienne Carmack, MD

Last Updated: 9/1/2011

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