Undescended testicles

What is an undescended, or a undescended, testicle?
During normal fetal development, a boy's testicles form in his abdomen alongside the kidneys. By the time the baby’s born, his testicles have moved down into his scrotum. If one or both don’t “drop,” he has a condition called undescended testicles. 

However, here at Children’s Hospital Boston, we prefer to call the condition “undescended testicles.”

Here’s why: An undescended testicle is a testicle that never moves downward from the abdomen into the scrotum (the bag of skin hanging behind and under the penis). A undescended testicle does come down—just not completely. That’s what we see in most cases. Mal-descent can affect one or both testicles. 

• Undescended testicles, or cryptorchidism, is a painless condition.
• The condition is present at birth.
• One to two percent of male infants are affected. Premature babies are affected by undescended testicles at a higher rate.
• The more premature your baby is, the higher the chance of having an undescended testicle.
• Testicles that do not descend into the scrotum are more prone to injury or torsion (when the blood supply is cut off), rendering the testicle unviable.
• In some cases—about 20 percent—a undescended testicle will resolve itself (or “drop”) on its own within your child’s first three or four months of life. Those that don’t will require surgery.

Is surgery always required to treat undescended testicles?
Some undescended testicles will eventually move into their proper position without any sort of treatment within the first three to four months of a baby’s life; those that do not will need to be moved surgically.

What are the problems associated with a undescended testicle?
Undescended testicles can increase the risk of infertility. Normally, when the testicles are in the scrotum, they’re about 3 to 5 degrees cooler than they would be if they remained inside the body's abdominal cavity. The warmer temperatures inside the body may impair the development of the testicles and may affect the production of healthy sperm.

Boys born with undescended testicles are also slightly more prone to testicular cancer, even after corrective surgery. The advantage of surgery, however, is that it moves the testis into a place that allows for routine self-examination, which could lead to early detection of any abnormalities later in life. 

Causes

What causes undescended testicles?

Experts have yet to identify any single cause of undescended testicles. The following factors may interfere with the normal descent and development of the testicles:

• abnormal anatomy
• health of the mother during pregnancy
• hormonal problems
• environmental influences

Signs and symptoms

What are the symptoms of undescended testicles?

In a baby affected by undescended testicles, one or both of his testicles either appear to be missing, or cannot be felt in the scrotum.

If both testicles are undescended, the scrotum will look unusually small and flat. If only one testicle is affected, the scrotum may look lopsided. 

If your baby's testicle appears to be “sometimes there and sometimes not,” we call that testicle retractile. It’s a normal condition that requires no treatment.

Questions to ask your doctor

After your child is diagnosed, you may feel overwhelmed with the information you are receiving. It can be easy to lose track of the questions that come to mind. 

Lots of parents find it helpful to write down questions as they arise; that way, when you talk to your child’s doctors, you can be sure that all of your concerns are addressed. Here are some initial questions to get you started:

• How did you arrive at this diagnosis?
• Are there any other conditions my child might have in addition, or instead?
• Does my child need surgery, and if so, what procedure do you recommend and why?
• What role should I play in my child’s treatment?
• What other resources can you point me to for more information?

FAQ

Q: Do undescended testicles cause pain?
A: No, your child does not feel any pain associated with his condition. 

Q: Will my child need X-rays?
A: In most cases, a doctor will not be able to feel a undescended testicle by hand. However, imaging is not always necessary to evaluate for testicles that have not descended into the scrotum.

Ultrasounds, computed tomography (CT) scans, and magnetic resonance imaging (MRI) have not been shown to be beneficial or helpful in the management of undescended testicles.

Q: Will my child need surgery?
A: If your child’s testicle does not descend on its own, his pediatric urologist will most likely recommend surgery to move it down into the scrotum before your baby's first birthday. This surgery, called orchiopexy, is necessary in order to improve your son’s body image through adolescence and adulthood, and to reduce long-term effects like risk of cancer or infertility. 

• Warmer temperatures inside the body can impair the development of the testes and may affect the production of healthy sperm. Orcheopexy moves the testes into the scrotum, where they’re about 3 to 5 degrees cooler than they would be if they remained inside the abdominal cavity. This improves the chances of fertility later in life. 
   
• Orchiopexy also makes it possible (by moving the testes into the scrotum) for young men to easily and routinely examine their testes in order to detect any abnormalities, including cancer.

Q: How can orchiopexy reduce my son’s chances of being infertile or developing undiagnosed testicular cancer?
A: Warmer temperatures inside the body can impair the development of the testes and may affect the production of healthy sperm. Orcheopexy moves the testes into the scrotum, where they’re about 3 to 5 degrees cooler than they would be if they remained inside the abdominal cavity. This improves the chances of fertility later in life. 

Orchiopexy also makes it possible for young men to easily and routinely examine their testes in order to detect any abnormalities, including testicular cancer. 

Q: Will my child’s genitals look “normal”?
A: The surgeons at Children’s will do everything in their power to make your son’s genital area look as normal as possible. Further genital repair is generally not necessary, though the area will be re-evaluated at different points in care and/or at different ages in your child’s development. 

Q: Will my son still go through puberty?
A: Yes, your son should still go through puberty.

Q: If I have another son, will he also have undescended testicles?
A: There is no evidence that undescended testicles have a genetic component.

Q: Will my son be able to play sports?
A: Definitely! The expectation is that your son should be able to enjoy a normal, active childhood just like his siblings, friends and classmates.

Q: Will my son be able to have children of his own?
A: Undescended testicles may increase the risk of infertility. However, boys who have one undescended testicle tend to father children at the same rate as those who are not affected by the condition at all. Boys who have two undescended testicles—a much lower percentage of patients—do have a significantly lower fertility rate.

Q: What are the chances my son may develop testicular cancer when he gets older?
A: Boys born with undescended testicles are slightly more prone to testicular cancer, even after corrective surgery, at a rate of less than 10 percent.

However, recent studies suggest that surgical repositioning may help in early detection of abnormalities, which in turn may reduce the rate of malignancies.

The good news is that in this day and age, virtually no one dies of testicular cancer, given the treatments we have available. At Children’s, we are at the forefront of research into the best ways to improve the long-term outlook for boys born with undescended testicles.