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Testicles that don’t descend into the scrotum before birth are referred to as undescended testicles. Cryptorchidism is another name for it. Most frequently, there is only one testicle that does not drop into the scrotum, the pouch of skin hanging behind the penis. However, occasionally both testicles may be affected.
Premature babies are more likely than full–term babies to have an undescended testicle. The condition occurs in about 3% of newborns, but they can occur up to 30% more frequently in premature infants. Within a few months after the infant is born, an undescended testicle frequently descends on its own. Surgery can be performed to move the testicle into the scrotum if your kid has an undescended testicle that doesn’t go down on its own.
Symptoms
The primary sign of an undescended testicle is neither the ability to see nor feel a testicle in the scrotum.
The development of testicles occurs within the lower abdominal region of an unborn baby. The testicles usually descend from the region of the stomach during the final few months of pregnancy. They enter through the inguinal canal, a tube–like passage in the groin, and then descend into the scrotum. That procedure halts or is delayed in the presence of an undescended testicle.
During a checkup performed soon after birth, an undescended testicle is frequently found. Ask how frequently exams will need to be performed if your child has an undescended testicle. By 3 to 4 months of age, the testicle should have shifted into the scrotum; otherwise, the problem is likely to persist.
Treatment of an undescended testicle when the child is still a baby may reduce the likelihood of health issues in the future. Testicular cancer and infertility, the inability to get a spouse pregnant, are examples of this.
In older boys, ranging from infants to preteens, who were born with descended testicles, it is possible for one or both testicles to appear to be absent at a later stage. This observation could be indicative of:
- Ascending testicle. The testicle went back up in the groin. It is difficult to manually insert the testicle into the scrotum. This also known as an acquired undescended testicle.
- Retractile testicle. The testicle alternates between the scrotum and the groin. During a physical examination, the testicle could be effortlessly guided into the scrotum by hand. A scrotal muscle reflex causes a testicle to retract.
If you see any changes in your child’s genitals or if you have any other worries, speak with their physician or another member of their care team.
Causes
It is unknown what specifically causes an undescended testicle. A combination of genes, the mother’s health, and other variables may be at play. They may interfere with each other and the hormones, physiologic changes, and nerve activity that affect how the testicles develop.
Risk factors
A newborn’s risk of having an undescended testicle may be increased by:
- Low birth weight or being born prematurely.
- An undescended testicle history in the family.
- Baby health issues, such as cerebral palsy or an issue with the abdominal wall.
- Cigarette smoking or being among people who smoke while pregnant.
- Being exposed to some insecticides while pregnant.
- Consuming alcohol while pregnant.
Pregnancy–related or gestational diabetes in the mother.
Diagnosis
To diagnose and address the issue with an undescended testicle, surgery may be required. There are two primary surgical procedures:
- Laparoscopy. Through a little cut in the abdomen, a tube containing a camera is inserted. To detect a testicle in the stomach region, a laparoscopy is performed.
During the procedure, the surgeon might be able to repair the undescended testicle. Yet another operation might be required. Laparoscopy may occasionally fail to detect an undescended testicle. Or the surgeon can detect inoperable or dead testicular tissue and remove it.
- Open surgery. In order to locate the undescended testicle, a bigger cut is used in this procedure.
More tests might be required if a newborn’s testicles cannot be located in the scrotum after birth. These tests can reveal whether the testicles are undescended or missing, which means not present at all. If they are not identified and treated, several medical conditions that cause absent testicles might have serious consequences very soon after birth.
In most cases, imaging tests like an ultrasound and MRI are not required to determine whether a baby has an undescended testicle.
Treatment
The aim of treatment is to reposition the undescended testicle in the scrotum. Treatment before the age of one may reduce the chance of health issues including infertility and testicular cancer associated to an undescended testicle. Early intervention is preferable. Experts frequently advise having the procedure done before the child is 18 months old.
Surgery
The most common treatment for an undescended testicle is surgery. The surgeon carefully repositions the testicle, placing it within the scrotum and securing it in position with sutures. Orchiopexy is the term for this. A tiny cut in the groin, the scrotum, or both can be used for the procedure.
Numerous factors will determine when your kid will have surgery. Several factors are taken into consideration, such as the infant’s condition and the complexity of the procedure, in order to assess the feasibility and difficulty level of the surgical intervention. Your doctor would probably advise having the procedure performed when your infant is between the ages of 6 and 18 months. Early surgical intervention appears to reduce the likelihood of future health issues.
The testicle may occasionally be harmed or composed of dead testicular tissue. This tissue needs to be removed by the surgeon.
Inguinal hernias are treated during surgery if your infant also has one.
Following surgery, the surgeon keeps an eye on the testicle to make sure it develops, functions well, and remains in place. Monitoring could consist of physical assessment, scrotal ultrasound, and hormone level monitoring.
Hormone treatment
Your child receives doses of a hormone known as human chorionic gonadotropin as part of hormone therapy. The testicle may relocate to the scrotum as a result of this. However, hormone therapy is frequently not advised because it is significantly less successful than surgery.
Other treatments
Other therapies might be helpful if your child doesn’t have one or both testicles because one or both are missing or were removed during surgery.
Consider exploring the option of acquiring testicular prostheses for your child, as these synthetic implants can help restore a natural appearance to the scrotum. They are surgically implanted in the scrotum. After puberty or at least six months after a scrotum operation, they can be implanted.
You can be directed to an endocrinologist, a hormone specialist, if your child doesn’t have at least one healthy testicle. You two can discuss potential hormone therapies that would be required to induce puberty and physical maturation.
Results
The most frequent procedure to correct one undescended testicle is orchiopexy. It is almost always successful. Most of the time, after surgery for a single undescended testicle, the chance of fertility issues disappears. Surgical intervention for two undescended testicles may result in a comparatively lesser degree of improvement. Additionally, surgery may lessen the chance of testicular cancer, but it does not eliminate it.
