What are Undescended Testicles (Cryptorchidism)?

Causes

What Causes Undescended Testicles?

In most children with this health issue, it's not known why the testicles fail to drop. It may be because the testicles aren't normal to start with. In other cases, there's a mechanical problem. The testicles drop but miss the scrotum, ending up next to the scrotum instead. These are called "ectopic testicles." Or it may be that the baby's hormones can't stimulate the testicles normally. No studies have shown that the problem is caused by something the mother did or ate during pregnancy.

Sometimes the testicles drop but don't attach in the scrotum. Then, when the boy grows, it becomes clear that the testicles aren't attached. About 1 of every 5 cases of undescended testicles are found once the boy is no longer a baby. For this reason, all boys should have the location of their testicles checked during each annual physical exam.

Diagnosis

How are Undescended Testicles Diagnosed?

A testicle that can't be felt in a physical exam is called "nonpalpable." Nonpalpable testicles may be in the abdomen (undescended), absent, or very small ("atrophic"). It's important to find out whether there is a testicle that hasn't dropped. An undescended testicle left inside the abdomen could form a tumor later in life. Such a tumor might not be noticed until it becomes quite large or causes symptoms. Unfortunately, there's no test, such as an ultrasound, that can definitively show whether a testicle is there. Surgery is the only way to find out for sure.

Pediatric urologists are experts in both open and laparoscopic surgery. Laparoscopy is surgery done through thin tubes put into your child's body through a small cut. The surgeon uses a special camera to see inside your child's body. The surgeon will find one of 3 situations:

  1. Blind-ending testicular blood vessels – proving there's no testicle
  2. Vessels leaving the abdomen – proving there's no testicle in the abdomen
  3. A testicle in the abdomen. If a testicle is found, it's brought down into the scrotum or removed, based on its condition.

Treatment

How are Undescended Testicles Treated?

The testicle won't drop after 3 months of age, so the only treatment choice is surgery. Surgery is recommended after 6 months of age. The timing takes into account when the child is able to handle anesthesia and the surgery. Drugs or hormone treatment aren't useful.

This surgery is called an orchiopexy. The child is put under (general anesthesia) for this surgery. Almost always the child can go home the same day and is back to normal within 1 to 2 days. A cut about 1 inch long is made in the groin area (most often it can hardly be seen later). The testicles is freed from all nearby tissues so that it moves easily into the scrotum. Then it is stitched into place. If there's a hernia, it's fixed at the same time. In some cases, the testicle is too high for this simple surgery. If this is the case, more complex methods (and sometimes even 2 surgeries) are needed. Overall, the success rate with surgery is 98 out of 100.

After Treatment

What Can I Expect after Treatment?

After treatment, the testicle often grows to normal size in the scrotum. In some cases, the testicle wasn't normal to start with, and never grows the right way. In other cases, sperm never grow, even though the testicle size is normal. In most cases, after treatment for 1 undescended testicle, fertility becomes normal and the chances of fathering a child in the future are high. When the child becomes a teen, he should have routine physical exams and do monthly testicular self-exams. Routine physicals will look for signs of testicular cancer, which remains a slight risk.

More Information

More Information

Frequently Asked Questions

Is an undescended testicle always found in babies?

No. About 1 of every 5 cases of undescended testicles are found after the boy is no longer a baby. The testicles of these boys appeared to have dropped normally as babies. If an undescended testicle appears later it is called an "ascending testicle." This happens because the testicle doesn't "fix" itself in the scrotum, and is noticed as the child grows. Often these boys are known to have a retractile testicle before they are diagnosed with an ascending testicle. These testicles need surgery to move them into the scrotum. Sperm won't mature if the testicle stays undescended. For these reasons, boys should have their genitals checked during their yearly physical exam.