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Undescended Testicle (Cryptorchidism)

Definition:
During development of a male fetus, the testes begin growth in the abdomen and migrate into the scrotum as gestation progresses. The descent usually occurs during the seventh and eighth months of gestation.

Males whose testes do not naturally complete the descent — so that one or both testicles fail to move into the scrotum — have a condition known as undescended testicle, or cryptorchidism.

An undescended testicle often resolves on its own. In cases that don't self-correct, surgery may be recommended to move and anchor the testicle into its proper position in the scrotum. The procedure is usually done between the baby's first and second years. Hormonal therapy to induce testicular descent also may be an option.

Uncorrected cases of undescended testicle may cause future fertility problems, such as decreased sperm production. Men who have had an undescended testicle — surgically corrected or not — have an increased risk of testicular cancer.

Undescended testicle is more common in premature infants — affecting up to 30 percent at birth — as they are more likely to be born before the testicles have descended. In full-term babies the incidence is 3 percent to 5 percent at birth.

Causes:
In the fetus, the testes begin their development in the abdomen then normally move downward through the inguinal canal and into the scrotum.

Anything that affects that process of descent is thought to play a role in causing cryptorchidism, although the exact cause is unknown. Proposed possible causes include hormonal abnormalities during gestation or an abnormally developed testis.

If one or both testes are completely absent, torsion — a twisting of the blood supply to the gonads during gestation — may be the cause. Torsion of the testes can occur in descended testicles also. Sometimes, the gonads simply do not develop.

Risk Factor:
The following factors may increase the risk of cryptorchidism:
  • The mother has a family history of unexplained newborn deaths or abnormal genitalia
  • The fetus has been exposed to increased or decreased levels of certain hormones during gestation
  • The fetus has Down syndrome
  • The fetus has disturbances to the endocrine system, which regulates release of hormones
  • The mother is younger than 20 or older than 35
  • The mother has been exposed to pesticides or other toxic chemicals
  • The mother is in poor health
When to seek medical advice:
Undescended testicle is typically detected shortly after birth. However, if you observe that your newborn's testicle or testes have not descended into the scrotum, talk to your child's doctor. Prompt diagnosis and treatment may help prevent fertility problems or testicular cancer later in life.

Symptoms:
If your son has an undescended testicle, you'll observe that his testicle or testes have not completely moved down into the scrotum. This means the testes may still be in the abdominal cavity or partway down the inguinal canal — the passageway between the abdominal wall and the scrotum. In very few cases, testicles may never have formed. If both testes are completely undescended, it's common to do chromosome testing to verify the sex of the baby.

Dignosis:
Undescended testicle is typically diagnosed during the newborn examination. The doctor examines your baby's groin area, from the hip down to the scrotum.

Diagnosis is made if the testicle is not in its normal location in the scrotum. The doctor will then attempt to locate the testicle in the inguinal canal or elsewhere in the groin area. Ultrasound may be needed to locate the testicle(s) when in the abdomen.

Imaging studies such as X-rays or ultrasound may be used to help diagnose the condition. The doctor may also refer your baby to a pediatric urologist — a specialist in the area of urinary and reproductive organs — for further evaluation.

A suspected case of undescended testes must be differentiated from retractile testes, whereby a testicle moves back and forth between the groin and the scrotum. In the past retractile testes weren't considered a clinical problem needing treatment. But recent studies show that retractile testes can later ascend (acquired undescended testicle), requiring treatment.

Complication
Undescended testicles can cause complications including:
  • Testicular cancer later in life.
  • Fertility problems. Lowered sperm count, sperm quality and fertility rates; sterility.
  • Testicular torsion. The blood supply to the testicles is cut off due to twisting of the spermatic cord.
  • Inguinal hernia. The intestines are pushed through the inguinal canal.
  • Male breast cancer.
  • Blunt trauma or injury to the testicle due to compression against the pubic bone.
Men who have had an undescended testicle — surgically corrected or not — have a tenfold increase in risk of developing testicular cancer. Between 3 percent and 5 percent of men who have had cryptorchidism will develop testicular cancer.

Treatment:
Testicles rarely descend on their own after six months of age. Once the doctor has determined the testicle is unlikely to descend naturally, hormonal therapy, surgery or a combination may be recommended.

Because descent of the testicle is partially regulated by hormones, normal descent can sometimes be induced with hormone therapy using human chorionic gonadotropin (HGC) HCG is the only hormone approved for treatment of undescended testicle in the United States. HCG is administered by injection, generally twice weekly for four weeks. Success rates are best when the testicle is located at the greatest distance from the scrotum.

More commonly, the doctor may recommend a simple corrective procedure known as orchiopexy or orchidopexy, which is typically performed when the boy is between 1 and 2 years of age. This involves making an incision at the groin and another at the scrotum to manipulate and stitch the testicle into place.

If the testicle can't be located, laparoscopic techniques may be needed. Laparoscopy involves a tiny video camera that's usually inserted in the abdominal area and navigated into the groin to help locate the testicle. Treatment options will be considered once the testicle is found.

In some cases the testicle may be completely absent. This can be confirmed with surgery or laparoscopy. In cases where both testes are absent, the doctor may want to check the baby's hormones and chromosomes to asses the baby for characteristics of an ambiguous genitalia disorder.

It's advantageous to correct undescended testicle as early as possible because sperm cell density has been shown to decrease as early as 1 year of age with this condition. In addition, risk of testicular cancer is higher in men with uncorrected conditions.
 
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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