What are undescended testicles?
The testicles develop in the abdominal cavity (torso) during gestation and in the latter stages of maturation before birth, they begin to descend into the scrotum. When one or both testicles are arrested in this descent, the condition is called cryptorchidism or undescended testicles.
This happens fairly commonly in premature infants and occurs about 3-4% of the time in full-term infants. About 65% of these usually drop before the age of nine months.
Testicles that do not drop by about one year of age should be examined by a surgeon. It is thought that by three years of age, if the testicles have not dropped, surgery should be done to prevent permanent damage to the testicles.
The proper positioning of the testicles in the scrotum, helps normalize sperm production and increases the odds of good fertility later in a boy's life. It also allows for early detection of testicular cancer which is more common in patients who experience undescended testicles.
The Glickman Urological and Kidney Institute is a world leader in treating both pediatric and adult urologic problems. The Institute's surgeons have pioneered diagnostic and surgical procedures that are minimally traumatic and significantly shorten recovery periods.
What causes undescended testicles?
The exact cause of an undescended testicle isn't known. Some researchers suspect possibly genetics, hormonal disruption, nerve activity, and material health as potential causes of abnormal testicle development in infants.
Other complicating factors can play a role in the frequency of undescended testicles occurrence. Including:
- Alcohol or cigarette exposure by the mother during pregnancy
- Premature birth
- Co-conditions that restrict fetal development, such as Down syndrome or an abdominal wall defect
- Obesity or diabetes in the mother (including type 1, type 2, or gestational diabetes)
- Family history of undescended testicle or other problems of genital development
What are the symptoms of undescended testicles?
Not seeing or feeling a testicle where you would expect it to be in the scrotum is the main sign of an undescended testicle.
Testicles form in the abdomen during fetal development. During the last couple of months of normal fetal development, the testicles gradually descend from the abdomen through a tube-like passageway in the groin (inguinal canal) into the scrotum. With an undescended testicle, that process stops or is delayed.
When to See a Doctor for Undescended Testicles
An undescended testicle is typically detected when your baby is examined shortly after birth. If your son has an undescended testicle, ask the doctor how often your son will need to be examined. If the testicle hasn't moved into the scrotum by the time your son is 4 months old, the problem probably won't correct itself.
Treating undescended testicle when your son is still a baby may lower the risk of complications later in life, such as infertility and testicular cancer.
Older boys — from infants to pre-adolescent boys — who have normally descended testicles at birth might appear to be "missing" a testicle later. This condition might indicate:
A retractile testicle, which moves back and forth between the scrotum and the groin and may be easily guided by hand into the scrotum during a physical exam. This is not abnormal and is due to a muscle reflex in the scrotum.
An ascending testicle, or acquired undescended testicle, which has "returned" to the groin and can't be easily guided by hand into the scrotum.
If you notice any changes in your son's genitals or are concerned about his development, talk to your son's doctor.
How are undescended testicles diagnosed?
A simple, routine physical examination determines if the testicles have descended. If they have not, a policy of watchful waiting is initiated because often, they will correct themselves without any assistance. If they have not descended after six months or longer, consideration is given to medical interventions.
Sonography may be employed to identify their state and pinpoint their location even though in many instances they can be felt as small bumps in the abdomen. Sonography bounces sound waves off of tissues and structures and uses the echoes to form an image, a sonogram. Blood tests may be run to determine hormone levels. An imbalance of hormones may be one of the reasons why the testicles have failed to descend.
If your son has an undescended testicle, his doctor may recommend surgery as potential treatment.
How are undescended testicles treated?
If addressed effectively and early enough, treatment for undescended testicles by Cleveland Clinic experts will move the undescended testicle into the scrotum. Some research has shown that treating the condition early can lead to reduction of risks such as testicular cancer and infertility later in life.
Treatment may be hormonal, surgical or a combination of both. Some testicles will respond to intra-muscular injections of the hormone hCG (human chorionic gonadotropin) by completing their descent. Orchiopexy, an operation designed to bring an undescended testicle into the scrotum, is accomplished through either an open procedure or laparoscopically. Orchiopexy has a success rate of nearly 100 percent. Most Cleveland Clinic surgeons will do this procedure when the infant is between 6 and 12 months old.
In the open procedure, a small incision in made in the groin to locate and manipulate the undescended testicle and another is made in the scrotum. The testicle is moved into the scrotum and a few sutures are placed to stabilize it and hold it in place. Laparoscopic orchiopexy is essentially the same procedure conducted with a slender viewing scope inserted in the abdomen.
Although both procedures are outpatient procedures, laparoscopic diagnoses and surgery uses smaller incisions resulting in minimal blood loss and more rapid recovery. Glickman Urological and Kidney Institute surgeons are pioneers in laparoscopic approaches. Both open and laparoscopic orchiopexy procedures have a very high success rate. The patient is followed at one to two week intervals, primarily to evaluate healing from the surgical procedures.