Undescended Testicle: Symptoms, Risks and Treatment

Doctor examining newborn baby boy with undescended testicles.

What Is An Undescended Testicle?

An undescended testicle (cryptorchidism), is a testicle that has not lowered into its correct position in the scrotum prior to birth. Most of the time only one testicle is undescended. However, both testicles are affected in about 1 out of 10 cases.

Although having an undescended testicle is generally not a common condition, it is common among prematurely-born baby boys.

In the vast majority of cases, the undescended testicle will resolve by itself and eventually move into the correct position during the first few months following birth. Surgery can be performed to reposition an undescended testicle if it doesn’t correct itself on its own.

Causes

It is not known what causes an undescended testicle. It is possible that it is caused by a disruption of certain hormones, nerve activity, and bodily changes that affect the development of the testicles. These disruptions could possibly be due to factors involving the mother’s health, genetic abnormalities, and other environmental influences.

Signs and Symptoms

The primary symptom of undescended testicles is not being able to feel or see one or both testicles within the scrotum.

While the fetus is still developing, the testicles are formed in the abdomen. They eventually descend from the abdomen to the scrotum via the inguinal canal, which is a tube-shaped passage in the groin. If this process is interrupted or delayed, it will result in an undescended testicle.

Who Is At Risk?

The following factors could increase the chance of an undescended testicle occurring in a newborn:

  • Premature birth.
  • A birth weight that’s abnormally low.
  • Having relatives with undescended testicles or other issues with genital development.
  • Certain conditions that can limit fetal development (for example Down syndrome or a defect of the abdominal wall).
  • If the mother smokes cigarettes while pregnant and/or exposure to second-hand smoke.
  • If the mother consumes alcohol while pregnant.
  • If the parents have been exposed to certain pesticides.

Problems Associated With An Undescended Testicle

Several conditions can occur due to having an undescended testicle. The following are complications that can occur when a testicle is not positioned where it should normally be:

Fertility Issues – Men who have an undescended testicle are more likely to experience a low sperm count, decreased sperm quality, and reduced fertility. These problems can occur due to an abnormal testicle development and may worsen if left untreated.

Testicular Cancer – Testicular cancer typically starts to form in the cells of the testicle that develop immature sperm. It is not known what causes these cells to become cancerous. Testicular cancer is more common in men who have had their an undescended testicle.

The risk for developing cancer is increased when the condition affects both testicles, and when the undescended testicle is located in the abdomen rather than the groin. The risk of developing testicular cancer in the future may be reduced by correcting an undescended testicle with surgery.

Testicular Torsion – This painful condition causes blood to stop flowing to the testicle due to the spermatic chord becoming twisted. The spermatic cord contains blood vessels and nerves, as well as the tube that transports semen to the penis from the testicle.

If this condition isn’t treated immediately, it could lead to the loss of the testicle. Testicular torsion occurs at a 10 times greater rate in undescended testicles compared to normal testicles.

Hernia – When the opening between the inguinal canal and abdomen is not firm enough, part of the intestines could push through into the groin, a condition known as an inguinal hernia.

Injury – A testicle that is positioned in the groin could become injured due to pressure against the pubic bone.

Seeing A Doctor

Usually, a baby is found to have an undescended testicle during an examination given shortly after birth. The testicle will correct itself in the majority of cases.

However, if the testicle doesn’t position itself into the scrotum within 4 months after birth, then the problem will probably not resolve by itself. Ask your doctor how often you will need to examine your son if he has an undescended testicle.

It is possible to reduce the chance of developing complications later in life (including conditions like infertility and testicular cancer) by treating an undescended testicle while your son is still a baby.

Additionally, boys who are born with testicles that have descended normally at birth may appear to have a testicle that is missing later on, sometime between infancy and pre-adolescence. This will normally happen for one of two reasons:

  • Retractile Testicle – A retractile testicle is a testicle that freely moves between the groin and scrotum. While it may be alarming, it’s actually not abnormal or a health risk. The testicle most often moves back down into the scrotum on its own, but sometimes may require a painless repositioning by hand. The majority of boys grow out of having retractile testicles.
  • Acquired Undescended Testicle – Sometimes a retractile testicle stays in the groin where it is no longer movable and cannot be easily guided by hand into the scrotum. This condition is known as an acquired undescended testicle or an ascending testicle.

Talk to your a physician if you notice any changes in your son’s testicles, or have concerns about his development.

Treatment

Your son’s doctor may recommend surgery in order to diagnose and possibly treat an undescended testicle.

Laparoscopy

This procedure involves using a camera on the end of a tube that is placed through a small incision made in the abdomen. A laparoscopic procedure is used to locate a testicle in the abdomen.

Although the doctor may be able to repair the undescended testicle during the procedure, some situations might require additional surgery. Additionally, laparoscopy may show that there is no testicle in the abdomen, or that there is a small amount of testicular tissue that is non-functioning that can then be removed.

Open Surgery

Sometimes, direct exploratory surgery of the abdomen or groin using a larger incision may be required. If the doctor cannot detect testicles in the scrotum after birth, additional testing may be necessary to determine if they are undescended or absent altogether. If left untreated, some conditions that cause an absence of testicles may lead to serious medical problems.

For diagnosing undescended testicles, imaging tests such as MRI and ultrasound are not typically recommended.

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