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Undescended Testicle

Conditions

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Cyptrorchidism (also known as undescended testicle) occurs when 1 or both testicles fail to move into the scrotum before birth. 

It occurs in approximately:

  • 10% of premature infants
  • 3% of full-term infants
  • 0.8% of boys at 6 months of age
  • 0.8% of boys during puberty

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Patients can be seen by Texas Children's experts in Urology.

Causes & Risk Factors

This condition occurs when testicles develop inside a fetus’ abdomen but do not descend to the scrotum during his mother’s pregnancy.

Undescended testicles can be part of a larger syndrome or, most commonly, an isolated finding. The cause remains unknown and is believed to include both genetic and environmental risk factors. Perinatal risk factors include prematurity, low birth weight, breech presentation and maternal diabetes.

Symptoms & Types

  • Retractile: This is NOT an undescended testicle but is often mistaken for one.  It is caused byoveractive muscles that pull the testicle(s) out of the scrotum. In this type the testicles can be placed in the scrotum manually and stay there for a short period of time.  This is a type of normal and does not need treatment.
  • Palpable (80%): In this type, (also called prepubic or inguinal) the testicle is located anywhere from just above the scrotum to high in the groin.
  • Nonpalpable (15%): This means the testicle is in the boy’s abdomen or is absent and  not felt in the scrotum or inguinal canal.
  • Ectopic (5%): In this case, the testicle has taken the wrong path and ended in an unusual location in the groin area.

Problems associated with undescended testicles include: inguinal hernia, risk of infertility, tumor and testicular torsion.

Diagnosis & Tests

Diagnosis is made solely by physical exam. The doctor will observe the shape and appearance of the scrotum, then feel or press with his hands to determine whether the testcle is palpable or nonpalpable and where it is located.

Scrotal ultrasound or other imaging is not necessary or recommended due to frequent false-positive or false-negative results.  In more complicated situations the pediatric urologist may rarely suggest a scrotal ultrasound.

Treatment & Care

No intervention is needed for retractile testicles. True undescended testicles diagnosed after 6 months of age need to be corrected with surgery or hormonal injections.

Palpable testicles will be corrected with a small incision in the groin on the affected side. The testicle is found and released from any attachments; any hernia sac found will be closed. An additional incision is made in the scrotum, the testis is pushed into the scrotum and a stitch anchors it in place.

Boys with nonpalpable testis generally undergo laparoscopic exploration, which consists of looking into the abdomen with a small camera to identify the testicle if present. Once identified, the testicle will then be placed in the scrotum in one or two stages (orchiopexy).

Hormonal treatment of undescended testes has limited success and is not generally suggested in the US.

Living & Managing

After surgery, your son will usually be discharged home the same day. His doctor will prescribe pain medicine for his discomfort, but children’s acetaminophen or ibuprofen is also helpful. He should not take a full bath for 3 days.  He should also avoid straddling toys such as bicycles, walkers and bounce toys, and strenuous activities for 2-3 weeks following the surgery.

Fertility: There can be abnormal semen found in 50% of adults with a history of  1 undescended testicle, and in 75% of those with a history of  2 undescended testes.  Actual fertility is minimally lower than the general population if only one side is involved.  If both testes are undescended the occurrence of infertility is higher.

Testis Tumor:   Patients with undescended testicles have a higher but undefined risk of testis tumor. Regular testicular self-exam is important after reaching puberty for these adolescents and men as it is for all men.

References & Sources

Baskin, Laurence and Barry Kogan, John Duckett. Handbook of Pediatric Urology. Philadelphia: Lippincott-Raven; 1997.

Abnormalities of the Testicle and Scortum. Campbell-Walsh Urology.  Wein, Kavoussi, Novick, Partin, Peters. 10th edition, vol. 1. 3560-3575.