UNDESCENDED TESTES

Testicles that don’t drop (called undescended testicles)

The testicles develop in the abdomen while a male baby is still in the uterus. Before birth, the testicles
typically drop from inside the abdomen down into the scrotum. The scrotum is the sack of skin
hanging behind the penis where the testicles are housed.

Undescended testicles fail to drop into the scrotum before birth or in the first few months of life. The
condition is also called cryptorchidism.

What causes undescended testicles?

Undescended testes are more often seen in babies who are born early (preterm or premature
babies).

There is no clear reason why some babies are born with undescended testicles. In some cases,
hormones could interfere with the testicles’ development.

The condition is more common in premature babies who haven’t had a full nine months to develop
before birth. There is no evidence that anything a mother does while pregnant causes a baby to have
undescended testicles.

What are the symptoms of undescended testicles?

Most babies and children with this condition have no symptoms. The only sign is that the scrotum is
empty.

What are the complications of undescended testicles?

After a boy goes through puberty, the testicles start producing sperm. To make healthy sperm, the
testicles need to be two to three degrees cooler than the body’s core temperature. That’s why the
testicles hang below the body, inside the scrotum.

If the testicles don’t drop into the scrotum, they may not function normally and produce healthy
sperm. This can lead to infertility later in life.

Males born with undescended testicles also have a higher risk of testicular cancer in adulthood. If the
testicles are in the abdomen and not down in the scrotum, this can make it more difficult to diagnose
and treat.

How are undescended testicles diagnosed?

Your child’s healthcare provider should physically examine your child’s testicles at each checkup. If
the testicles are “non-palpable” (meaning the provider cannot feel them), they may be undescended.

Your healthcare provider may recommend following up with a pediatric urologist. An ultrasound may
be recommended by the urologist, however they often are not necessary.

Undescended testicle treatment options include:

 Hormone therapy: In rare cases — especially when the testicles are near the scrotum — your
healthcare provider may recommend hormonal treatment. The healthcare provider gives the
child a series of hCG (human chorionic gonadotropin) injections. The hormones encourage the
testicles to drop into the scrotum.
 Surgery: Surgery is the most common, and effective, treatment for undescended testicles. The
procedure to move testicles down into the scrotum is called orchiopexy. It’s usually best for your
child to have surgery between six months and one year old.

Key diagnostic factors

 malpositioned or absent testis
 palpable cryptorchid testis
 nonpalpable testis

Other diagnostic factors

 testicular asymmetry
 scrotal hypoplasia or asymmetry
 retractile testis
 ascending cryptorchidism

Risk factors
 family history of cryptorchidism
 prematurity
 low birth weight (<2.5 kg) and/or small for gestational age
 environmental exposures

What Problems Can It Cause?

An undescended testicle is related to a number of conditions:

 Fertility problems. Because sperm need to be a little cooler than the rest of the body, an
undescended testicle can cause fertility issues. This is more of a problem when both are lodged
in the groin. Early treatment can make a big difference.
 Hernia. This is a condition where part of the intestine bulges through the muscles of the lower
belly.
 Injury. When the testicle is out of place, it’s more likely to be damaged.
 Cancer. Men who have an undescended testicle are a little more likely to get testicular cancer,
even if they have surgery to treat it. But surgery makes routine self-exams possible, so
if cancer does appear, it can be found early.
 Testicular torsion. This is when the cord that carries semen to the penis gets twisted up. It’s
painful and can cut off blood flow to the testicle.

Recommended surgery for diagnosis and potential treatment:

 Laparoscopy. A small tube containing a camera is inserted through a small incision in your son's
abdomen. Laparoscopy is done to locate an intra-abdominal testicle.

The doctor might be able to fix the undescended testicle during the same procedure, but an
additional surgery might be needed in some cases. Alternatively, laparoscopy might show no testicle
present, or a small remnant of nonfunctioning testicular tissue that is then removed.

 Open surgery. Direct exploration of the abdomen or groin through a larger incision might be
necessary in some cases

Hormone treatment
Hormone treatment involves the injection of human chorionic gonadotropin (HCG). This hormone
could cause the testicle to move to your son's scrotum. Hormone treatment is not usually
recommended because it is much less effective than surgery.

Results
Orchiopexy, the most common surgical procedure for correcting a single descending testicle, has a
success rate of nearly 100 percent. Fertility for males after surgery with a single undescended testicle
is nearly normal, but falls to 65 percent in men with two undescended testicles. Surgery might reduce
the risk of testicular cancer, but does not eliminate it.