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by Smith N

Undescended Testes

(Cryptorchidism)

Definition

A child's testicles develop before birth. They start inside the abdomen. The testicles should then move down into the scrotum just before birth. Undescended testes stay in or return to the abdomen. A true undescended testicles situation is present at birth. The testicle remains in the abdomen until treated. Other situations that allow the testicles to go up into the abdomen include:
  • Retractile testicles—the testicles can move freely between the scrotum and abdomen. This condition does not require treatment and usually disappears by puberty.
  • Ascending testicles—a normal testicle returns to the abdomen
Undescended Testis
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Causes

Undescended testicles are often caused by a disruption in the development of the testicles. The cause of this disruption is not clear. Genetics may play a role. There may also be some problems with the hormones that help testes develop. The testicles may also have been injured at some point during the pregnancy.

Risk Factors

Factors that may increase your child's chance of undescended testicles include:
  • Prematurity
  • Low birth weight
  • Twin gestation
  • Down syndrome or other chromosomal abnormality in the fetus
  • Gestational diabetes mellitus
  • Prenatal alcohol exposure
  • Prenatal exposure to cigarette smoke
  • Hormonal abnormalities in the fetus
  • Toxic exposures in the mother
  • Having a mother younger than 20
  • A family history of undescended testes

Symptoms

The main symptom is not being able to see or feel the testicle.

Diagnosis

You will be asked about your child's symptoms and medical history. A physical exam will be done. A diagnosis is usually made during the physical exam. The doctor will note that one or both of the child’s testes cannot be felt within the scrotum.
Your child's bodily structures may need to be viewed. This can be done with ultrasound or laparoscopy.

Treatment

Undescended testicles are treated because they may increase the risk of certain health conditions such as:
  • Infertility or low fertility—A testicle is more likely to produce sperm in cooler temperature as in the scrotum, the heat inside the body is too high for sperm production.
  • Testicular cancer
  • Torsion—Testicles twist enough so that they cut off the blood flow to the testes. This can cause severe damage to the testicles.
  • Emotional distress—As the child ages, they may have problems with the appearance of the empty scrotum.
Talk with your doctor about the best treatment plan for your child. Treatment options include:
  • Giving the problem time to go away on its own:
    • In most children, the testes will descend on their own by four months of age.
    • Retractile testicles will completely descend at puberty. Further treatment is not needed.
  • Hormone therapy with human chorionic gonadotropin (HCG) :
    • This treatment is not used often.
    • The hormone helps stimulate testicle development. This may encourage the testicle to move down.
  • Surgery called orchiopexy:
    • The testicle is moved down and stitched into place.
    • It is often done with laparoscopic surgery. The doctor makes tiny incisions in the area.

Prevention

There are no current guidelines to prevent undescended testes.

RESOURCES

Healthy Children—American Academy of Pediatrics
http://www.healthychildren.org
National Infertility Association
http://www.resolve.org

CANADIAN RESOURCES

Health Canada
http://www.hc-sc.gc.ca
Infertility Awareness Association of Canada
http://www.iaac.ca

References

Cryptorchidism. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated May 21, 2014. Accessed June 3, 2014.
Docimo S, et al. The undescended testicle: Diagnosis and management. Am Fam Physician. 2000 Nov 1;62(9):2037
Undescended testicles. American Academy of Family Physicians Family doctor website. Available at: http://familydoctor.org/familydoctor/en/diseases-conditions/undescended-testicles.html. Updated April 2014. Accessed June 3, 2014.
Undescended testicles. American Academy of Pediatrics' Healthy Children website. Available at: http://www.healthychildren.org/English/health-issues/conditions/genitourinary-tract/Pages/Undescended-Testicles.aspx. Updated May 11, 2013. Accessed June 3, 2014.

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