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Undescended Testes (cryptorchidism)

  • Undescended testicles—a condition also called cryptorchidism—is actually fairly common. However, the name is a bit misleading, which is why it is sometimes also referred to as “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 congenital (meaning it 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 testicular torsion (when the blood supply is cut off), rendering the testicle unviable.

    • In some cases—about 20 percent—an 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.

    Parents of baby boys who’ve been diagnosed with undescended testicles often worry, “Will my son be able to have children of his own?” Fortunately, the answer is yes in most cases for boys with one undescended testicle.

     Long-term consequences are rare, but you should be aware of them:

    • Undescended testicles may increase the risk of infertility, especially if both testicles are affected. However, boys who have one undescended testicle tend to ultimately 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.

    • Undescended testicles are slightly more prone to develop testicular cancer, even after corrective surgery. However, surgery may reduce the risk of developing cancer. Parents should know that cases of cancer related to undescended testicles are rare.

    How Children’s Hospital Boston approaches undescended testicles

    Here at Children’s, we treat boys with undescended testicles in our Department of Urology. In fact, we have a dedicated Andrology Program within the department that focuses specifically on male hormone and reproductive disorders. (Andrology is the field of urology that studies and addresses conditions involving testicular function).

    The laparoscopic advantage

    In most cases, undescended testicles cannot be felt by hand. Boston Children's Hospital was the nation’s first hospital to use laparoscopy—a minimally invasive surgical procedure that involves looking into the abdomen with a very small telescope—to locate a testicle.

    • Boston Children’s Hospital is home to a Center for Minimally Invasive Surgery. Here at our center, we develop and refines surgical procedures that use tiny incisions and miniaturized, highly sensitive operating tools, cameras and telescopes.

    • Boston Children’s does more laparoscopic procedures than any other center in New England.

    • Our physicians also use laparoscopy to move a testicle into the scrotum. This permits the best growth and development possible for that testicle.

    • Most importantly, our clinicians are well-practiced in both laparoscopy and the treatment of undescended testicles in general: every week, we help as many as three to four kids with the condition. 

    Undescended testicles/cryptorchidism: Reviewed by Marc Cendron, MD
    © Boston Children’s Hospital , 2011


    Urology

    Boston Children's Hospital
    300 Longwood Avenue
    Boston, MA  02115

     617-355-7796


  • 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.

    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.

  • How will my son's physician diagnose an undescended testicle?

    A primary care doctor will first perform a full genital examination, and will try to locate the testicle if it is not in the scrotum. If one can't be felt, your son may be referred to a pediatric urologist or pediatric surgeon for a more complete examination and to rule out two related conditions:

    • Ectopic testes - If the scrotum is empty, the doctor may first try to determine if your child has ectopic testicles, a related condition in which the testicle is somehow diverted from its normal pathway of descent and as a result, lies in an abnormal location outside this pathway. To check for this, the physician will feel the areas where ectopic testes are sometimes located.

    • Retractile testes - Retractile testicles move in and out of the scrotum. Your doctor may try to rule out this condition by trying to bring the testicle downward. If the testis can be brought all the way into the scrotum, it is retractile and requires no treatment.

    If your doctor determines that the testicle is not ectopic or retractile, the diagnosis is usually an undescended testicle. Your child will then be referred to a pediatric surgeon for further evaluation.

  • How are undescended testicles treated?

    If your son's testicle does not descend on its own before his first birthday, his pediatric urologist will most likely recommend a type of laparoscopic surgery called orchiopexy to move the testicle down into the scrotum. 

    Orchiopexy

    • If the testicle can be felt in the groin, orchiopexy will probably be done through a small incision in the groin. The surgeon will free the testicle from its location in the abdomen and maneuver it into the scrotum. Children often go home later that day or the next morning. 
       
    • If the testicle cannot be felt in the groin (as occurs in about one out of five boys with a undescended testicle), the testicle may be in the abdomen, or may simply be absent. Further exploration is necessary to make sure a testicle is not left in the abdomen—in order to permit the testicle to function properly and to reduce the risk of cancer developing undetected in that testicle.
       
    • Some testicles have descended into the scrotum, but have not grown well and are not functional. They are best removed as well.

    Is surgery to correct a undescended testicle medically necessary?

    Not always. However, it's highly recommended 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. 

    How many surgeries will my child require?

    In most cases, doctors are able to repair a undescended testicle with a single, simple operation.

    At what age will the surgery take place?

    Most surgeries to treat undescended testicles occur between 6 and 12 months of age.

    What are the complications of the surgery?

    Complications from surgery are relatively rare but in some cases can include bleeding and infection. The most common complication—which is still quite rare—is when the moved testicle goes back up into the abdomen. In this case, doctors will need to perform another surgery. In very rare cases, a testicle can lose its access to blood supply, which will render it unviable. It will then become scar tissue. But again, this is very rare.

    How long will my son have to stay in the hospital after surgery?

    Kids often go home later that day or the next morning.

    What happens after surgery?

    Your son may feel some discomfort after his operation, but most boys feel better after about a day. Your doctor will probably recommend that your son avoid sitting on riding toys for about four weeks in order to prevent injury to the testicle. You can expect annual follow-up examinations so the urologist can check that the testicle is growing normally. 

    Coping and support

    No parents want their child to have a medical condition, and it's important to remember that you and your family aren't alone. Many families have been down this path, and there's a lot of support available here at Children's for you and your family. Here are some of the ways we can help:

    Patient and family resources at Children's

    Children's Center for Families is dedicated to helping families locate the information and resources they need to better understand their child's particular condition and take part in their care. All patients, families and health professionals are welcome to use the center's services at no extra cost. The Center for Families is open Monday through Friday from 8 a.m. to 7 p.m., and on Saturdays from 9 a.m. to 1 p.m. Please call 617-355-6279 for more information. 

    Our Behavioral Medicine Clinic helps children who are being treated on an outpatient basis at the hospital—as well as their families—understand and cope with their feelings about:

    • being sick
    • facing uncomfortable procedures
    • handling pain
    • taking medication
    • preparing for surgery
    • changes in friendships and family relationships
    • managing school while dealing with an illness
    • grief and loss

    Children's Integrative Therapies Team offers several different types of therapies for hospitalized kids, as well as consultations and educational sessions for parents and healthcare providers. The team specializes in treatments that can complement a child's medical care, including:

    • acupuncture
    • art therapy
    • massage therapy
    • music therapy
    • reiki
    • therapeutic touch
    • yoga

    Children's Psychiatry Consultation Service is comprised of expert and compassionate pediatric psychologists, psychiatrists, social workers and other mental health professionals who understand the unique circumstances of hospitalized children and their families. The team provides several services, including:

    • short-term therapy for children admitted to one of our inpatient units
    • parent and sibling consultations
    • teaching healthy coping skills for the whole family
    • educating members of the medical treatment team about the relationship between physical illness and psychological distress

    Children's Department of Psychiatry offers a free booklet, “Helping Your Child with Medical Experiences: A Practical Parent Guide”(Adobe Acrobat is required). Topics in the booklet include:

    • talking to your child about her condition
    • preparing for surgery and hospitalization
    • supporting siblings
    • taking care of yourself during your child's illness
    • adjusting to life after treatment

    Children's International Center is a dedicated resource for patients and families from countries outside the United States. The center can provide assistance with everything from reviewing medical records to setting up appointments and locating lodging. Contact the center by phone at 01-617-355-5209 or via e-mail at international.center@childrens.harvard.edu

    On our “For Patients and Families” site, you can read all you need to know about:

    • getting to Children's
    • accommodations
    • navigating the hospital experience
    • resources that are available for your family
  • Children’s Hospital Boston is home to the world’s most extensive research enterprise at a pediatric hospital. 

    We also have many partnerships with research, biotech and health care organizations, and we work together to find innovative ways to improve kids’ health. 

    At Children’s, we are at the forefront of research into the best ways to better the long-term outlook for boys born with undescended testicles. We perform more laparoscopic surgeries each year than any other institution in New England. In fact, pediatric urologist Craig Peters, MD, performed the first-ever pediatric laparoscopy procedure to bring testicles down at Children’s. 

    In addition, Children’s researchers are examining the hormonal mechanisms related to the normal descent of a testicle, with the ultimate goal of one day developing hormonal therapies that will make surgery unnecessary. 

    Learn more about our research.

    Clinical trials

    Children’s is known for pioneering some of the most effective diagnostic tools, therapies and preventive approaches in pediatric medicine. A significant part of our success comes from our commitment to research—and to advancing the frontiers of health care by conducting clinical trials.

    Children’s coordinates hundreds of clinical trials at any given time. Clinical trials are studies that may involve:

    • evaluating the effectiveness of a new drug therapy
    • testing a new diagnostic procedure or device
    • examining a new treatment method for a particular condition
    • taking a closer look at the causes and progression of specific diseases

    Children’s is involved in several multi-site clinical trials and studies focusing on pediatric urology. While children must meet strict criteria in order to be eligible for a clinical trial, your child may be a candidate for participation in a study. Before considering this option, you should be sure to:

    • consult with your child’s treating physician and treatment team
    • gather as much information as possible about the specific course of action outlined in the trial
    • do your own research about the latest breakthroughs relating to your child’s condition

    Taking part in a clinical trial at Children’s is entirely voluntary. Our team will be sure to fully address any questions you may have, and you may remove your child from any medical study at any time. 

    Search current and upcoming clinical trials at Children’s                                                                       

    Search the National Institute of Health’s list of clinical trials taking place around the world

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