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Testicles, Undescended (Cryptorchidism)

Basic Information

Undescended testicles is a common abnormality or disorder that occurs at birth. One or both testicles, for reasons unknown, do not descend from the pelvis into the normal position in the scrotum. They remain in the abdominal cavity.

Testicular descent can also be incomplete or improper. In such cases, the testicles do lie within the inguinal canal but have been obstructed in this passageway by mechanical abnormalities.

Also, retractile or hypermobile testicles may fall down into the scrotum at specific times -- such as during a hot water bath -- but then the testicles retract back into the inguinal canal.

Undescended testicles occur in 30% of premature newborn males and in 3% of full-term newborn males, but most descend on their own during the first year without any treatment.

Causes in the case of undescended testicles that remain in the abdominal cavity are thought to be related to hormone deficiency in the foetus or in the mother. But hormone function usually is normal in cases of incomplete or improper descent or with retractile or hypermobile testicles. Another cause may be fibers which interrupt the path of the testicles, forcing one or both to stay in the groin.

It is not known if there are any risk factors involved for undescended testicles except genetic predisposition. A family history of undescended testicles does seem to increase the risk for newborns but there are no specific measures for the mother to take to reduce this risk or to prevent the disorder from occurring in the newborn. Obviously, premature newborns are at greater risk than full-term newborns.

Fortunately, treatment is generally able to foster a cure if the disorder is treated before puberty. Cure is achieved by the use of hormones or surgery, however surgery should usually be done before the child is two years old. An abnormal reproduction function may result if surgery is put off until the child is five years old or older.

There are both risks and complications associated with undescended testicles -- physical and psychological. Risks include:

  • An increased risk of testicular cancer. You have almost 15 times the risk of testicular cancer if you had undescended testicles, even if they were brought down into your scrotum during surgery. If you do not know if you had undescended testicles, ask your family members. Your health care provider may want to have you screened for testicular cancer as a young man (most cases of testicular cancer occur among young men or young adults).
  • Sterility
  • Low fertility rate

Complications include:

  • Hernia
  • Abnormal sexual development due to lack of testicles
  • Psychological disorder due to poor masculine self-image from lack of testicles

Symptoms

Symptoms include:

  • A scrotum that appears undeveloped -- this can be on one or both sides.
  • The testicle is not felt in its normal spot in the scrotum.

Diagnosis/Treatment

If the testicles are unable to be felt, diagnostic tests can include an ultrasound or CT scan.

Retractile or hypermobile testicles (lying in the scrotum at times and then retracting) usually fall into place by puberty.

True cases of cryptorchidism in which the testicles remain in the abdominal cavity need to be treated hormonally or with surgery.

Human chorionic gonadotropins (HCG) can be given as injections three times a week for four to six weeks. In 25% of cases the testicles descend normally with this treatment.

In the other 75% of cases, surgery must be done to remove or sew the undescended testicle into the scrotum. This type of surgery is called orchiopexy, and one of its main rewards is to put the testicle into a place where it is easy to examine -- a boon in light of the greatly increased risk for testicular cancer that accompanies this disorder.

A word should be said about the risk for hernia development later in life.

An inguinal hernia (a hole in the abdominal muscle) usually lies along the route where the testicle moved towards the scrotum before birth. Abdominal organs emerge through this hole and can get stuck in them or strangulate in them. Over time the hernia can become so large that it can get stuck in the scrotum.

If you have an inguinal hernia:

  • Get it repaired -- surgery is indicated. If you ignore it it can cause serious problems later that could become life-threatening.
  • A large hernia can block and not provide access to the testicles which you need to examine for testicular cancer, especially if you have had undescended testicles.

If your child has undescended testicles or if you are a man who has had undescended testicles and would like to be screened for testicular cancer, please see your health care provider promptly.