Undescended Testicles

What Are Undescended Testicles?

Undescended testicles (also known as cryptorchidism) is a condition in which one or both of a baby boy's testicles (testes) have not moved down into their proper place in the scrotum.

How Do Undescended Testicles Happen?

As a baby boy grows inside his mother's womb, his testicles form inside his abdomen and move down (descend) into the scrotum shortly before birth. But in some cases, that move doesn't happen, and the baby is born with one or both testicles undescended. The majority of cases are in male babies born prematurely.

Undescended testicles move down on their own in about half of these babies by the time they're 6 months old. If they don't, it's important to get treatment. The testicles make and store sperm, and if they don't descend they could become damaged. This could affect fertility later in life or lead to other medical problems.

How Is Cryptorchidism Diagnosed?

Doctors usually diagnose cryptorchidism during a physical exam at birth or at a checkup shortly after. Most undescended testicles can be located or "palpated" on exam by the doctor.

In a few boys, the testicle may not be where it can be located or palpated, and may appear to be missing. In some of these cases, the testicle could be inside the abdomen.

Some boys may have retractile testes. This is a normal condition in which the testicles can appear to be outside of the scrotum from time to time, raising the concern of an undescended testicle. The testes usually are in the scrotum, but sometimes temporarily pull back up into the groin. A retractile testicle doesn't require treatment because it's a normal condition. But a pediatric specialist might need to do an exam to distinguish it from an undescended testicle.

How Are Undescended Testicles Treated?

If a testicle has not descended on its own by the time a baby is 6 months old, he should be checked by a pediatric specialist and have treatment if the condition is confirmed. This usually involves surgically repositioning the testicle into the scrotum.

Treatment is necessary for several reasons:

• Being up in the body means the undescended testicle is at a higher temperature than usual (testicles need to be below regular body temperature to produce sperm). The higher temperature may harm the testicle's development and its ability to make sperm in the future. This could possibly lead to infertility (the inability to father children).
• An undescended testicle is more likely to form a tumor than a normally descended testicle.
• The undescended testicle may be more at risk for injury or testicular torsion.
• An asymmetrical or empty scrotum can cause a boy worry and embarrassment.
• Sometimes boys with undescended testicles develop inguinal hernias.

If surgery is done, it's likely to be an orchiopexy (or-kee-oh-PEK-see). In this procedure, a small cut is made in the groin and the testicle is brought down into the scrotum, then fixed (or "pexed") in place. Doctors usually do this on an outpatient basis (with no overnight stay in the hospital), and most boys recover fully within a week.

Most doctors believe that boys who've had a single undescended testicle will have normal fertility and testicular function as adults, while those who've had two undescended testicles might be more likely to have reduced fertility.

Boys who've had undescended testicles should have regular follow-up appointments with a urologist to make sure that no problems develop.

All boys — even those whose testicles have properly descended — should learn how to do a testicular self-exam when they're teens so that they can find any lumps or bumps that might be early signs of medical problems.