What is an Undescended Testicle (Cryptorchidism)?

An undescended testicle (cryptorchidism) occurs when the testicle does not drop from the abdomen into the scrotum (sack of skin that hangs below the penis) before birth. Typically, only one testicle is impacted, however, in some cases, both testicles are undescended.

Cryptorchidism is somewhat common but tends to develop more often in premature males. Usually, the condition resolves on its own in the first few months of life. Cases that do not resolve on their own require surgery to move the testicle to its proper position in the scrotum.

There are several reasons a testicle may not descend, which includes:

• The testicle has not properly descended from the abdominal cavity
• A twist or blockage of the testicle’s blood vessels may have shrunk the testicle
• The testicle may not have formed at all to begin with

Signs and Symptoms

Babies with undescended testicles (cryptorchidism) do not have any noticeable symptoms other than an empty scrotum. If the condition is left untreated, cryptorchidism may lead to fertility issues as well as increasing your risk for testicular cancer and an inguinal hernia.

Causes

There is no known cause for cryptorchidism, but it has been speculated that hormones may sometimes interfere with the development of the testicles. Babies who are born prematurely and have not had the full nine months to develop are at a greater risk of experiencing cryptorchidism. Additionally, some experts have theorized that a combination of genetics, environmental factors, and possibly maternal health may play a role in the development of the testicles, but further research is needed.

Risk Factor

There are several factors that may put a baby at a greater risk of developing cryptorchidism. Although further research is needed to confirm the cause of undescended testicles, there are potential risk factors that may contribute to its development. Potential risk factors include:

• Premature birth
• Low birth weight
• Family history of cryptorchidism or other issues with genital development
• Conditions of the fetus that may restrict growth (down syndrome or abdominal wall growth)
• Smoking or exposure to secondhand smoke during pregnancy
• Alcohol use during pregnancy
• Exposure to certain pesticides

Diagnosis

To diagnose an undescended testicle, a doctor will conduct a physical examination. If the testicles are non-palpable, meaning the doctor cannot feel them, further testing may be recommended. Additionally, your baby may be referred to a pediatric urologist.

Generally, imaging tests are not deemed as necessary. However, some doctors may recommend an ultrasound, X-ray, MRI, or CT scan if they are unable to locate the testicle. On some occasions, a pediatric urologist may recommend further testing or procedures that aid in diagnosis and treatment, known as a laparoscopy or open surgery, which is less common.

Treatment

Treatment for undescended testicles is strongly recommended to happen by the first 18 months of life. The most common time is between 6 and 12 months. Data shows that the earlier the treatment, the better the short and long-term outcomes. Specifically, the earlier the treatment, the less likelihood there is for your child to experience infertility issues or testicular cancer later in life. The recommended timeline for your child’s surgery will be determined by your child’s health and how severe the issue is.

An undescended testicle is typically repaired with surgery. There are two options for the type of surgery your child will receive. The two different types are laparoscopic, or open surgery. The surgery will attempt to move the testicle into the scrotum and stitch it into place (orchiopexy).

In some instances, the testicle is underdeveloped, abnormal, or has dead tissue. Your child’s doctor will surgically remove the testicular tissue. If an inguinal hernia is detected during the procedure, the doctor will also remove the hernia. Continued monitoring and testing will occur after surgery to assess whether the testicle is developing normally. Tests include:

• Physical exams
• Ultrasound of the scrotum
• Hormone tests

Prevention

There is no known way to prevent undescended testicles.

Complications

There are several complications that can occur if undescended testicles are left untreated. Testicles need to be in an environment 2 to 3 degrees cooler than the body’s core temperature to produce healthy sperm. This is why testicles descend into the scrotum, which hangs outside of the body. Undescended testicles can lead to infertility issues. Additionally, undescended testicles increase the risk of developing testicular cancer, testicular torsion, and inguinal hernias.

As with any surgery, there is some risk of potential complications, such as causing structural damage to the vas deferens, the tube that connects each testicle to the urethra. Consult with your healthcare provider to discuss any concerns.