What is Undescended Testicle? Symptoms, Causes, & Treatment

An undescended testicle happens when one or both testicles don't move down into the scrotum before birth. This condition, also called cryptorchidism, affects about 3-4% of full-term baby boys and is one of the most common birth differences involving male reproductive organs.

During normal development, testicles form inside a baby's abdomen and gradually descend into the scrotum during the last few months of pregnancy. When this natural journey doesn't complete, the testicle remains somewhere along the path between the abdomen and scrotum.

What are the symptoms of undescended testicle?

The main sign is pretty straightforward - you can't feel one or both testicles in their expected place in the scrotum. When you gently examine the scrotum, it may feel empty or smaller on one side compared to the other.

Most babies with this condition don't experience pain or discomfort. The undescended testicle typically doesn't cause any immediate health problems, which is why many parents first notice it during routine diaper changes or bath time.

Sometimes you might be able to feel a small, movable lump in the groin area where the undescended testicle has settled. This lump is usually soft and painless to touch.

What are the types of undescended testicle?

There are several types based on where the testicle stops during its journey downward. Understanding these differences helps doctors plan the best treatment approach for each child.

• Retractile testicle: The testicle has descended properly but pulls back up into the groin due to an overactive muscle reflex
• Inguinal testicle: The testicle stops somewhere in the groin area, often feeling like a small lump
• Abdominal testicle: The testicle remains inside the abdomen and can't be felt from outside
• Ectopic testicle: The testicle descends but ends up in an unusual location, like the thigh or base of the penis

Most cases involve just one testicle, though both testicles can be undescended in about 10% of cases. The distinction between these types helps your doctor determine whether the testicle might descend on its own or needs medical intervention.

What causes undescended testicle?

The exact cause often remains unknown, but several factors can interfere with the testicle's normal descent during pregnancy. Think of it as a complex process that sometimes doesn't complete as expected.

Hormonal factors play a significant role in guiding testicles downward. If certain hormones like testosterone or insulin-like hormone aren't produced in adequate amounts, the testicle may not receive proper signals to descend.

Premature birth increases the likelihood since testicles typically make their final descent during the last two months of pregnancy. Babies born before 37 weeks haven't had full time for this natural process to complete.

Some genetic conditions can affect testicle development and descent. These include chromosomal disorders or inherited syndromes that influence hormone production or physical development of reproductive organs.

Physical barriers or abnormal development of the pathway from abdomen to scrotum can also prevent normal descent. Sometimes the natural channel isn't wide enough or doesn't form correctly during early pregnancy.

When to see a doctor for undescended testicle?

You should have your baby examined by a pediatrician within the first few months of life if you notice an empty or partially empty scrotum. Early evaluation helps distinguish between different types and determines the best monitoring approach.

If your child is older than six months and still has an undescended testicle, it's time to consult a pediatric urologist. By this age, natural descent is unlikely to occur, and medical intervention may be necessary.

Seek immediate medical attention if you notice sudden pain, swelling, or color changes in the groin area or scrotum. These could indicate complications like testicular torsion, which requires emergency treatment.

Regular follow-up appointments become important as your child grows. Your doctor will monitor the testicle's position and watch for any signs of complications during routine checkups.

What are the risk factors for undescended testicle?

Several factors during pregnancy and birth can increase the chances of this condition developing. Understanding these risk factors helps explain why some babies are more likely to be affected.

• Premature birth: Babies born before 37 weeks have higher rates since testicles descend late in pregnancy
• Low birth weight: Smaller babies, regardless of gestational age, face increased risk
• Family history: Having a father or brother with undescended testicles increases likelihood
• Maternal diabetes: Uncontrolled diabetes during pregnancy can affect fetal development
• Maternal smoking or alcohol use: These substances can interfere with normal fetal development
• Exposure to certain chemicals: Some pesticides and industrial chemicals may increase risk

Having one or more risk factors doesn't guarantee your baby will have undescended testicles. Many babies with multiple risk factors develop normally, while others with no apparent risk factors can still be affected.

What are the possible complications of undescended testicle?

While undescended testicles don't cause immediate problems, leaving them untreated can lead to several concerns as your child grows. The good news is that early treatment prevents most of these complications.

Fertility problems represent the most significant long-term concern. Testicles need the cooler temperature of the scrotum to produce healthy sperm later in life. When testicles remain in the warmer environment of the abdomen or groin, sperm production can be impaired.

Cancer risk increases slightly, though it remains relatively low overall. Men with a history of undescended testicles have about a 3-5 times higher risk of developing testicular cancer compared to men without this condition.

Testicular torsion becomes more likely when testicles aren't properly positioned in the scrotum. This painful condition happens when the testicle twists on its blood supply, requiring emergency surgery to prevent permanent damage.

Inguinal hernias often accompany undescended testicles. The same opening that allows the testicle's descent can permit abdominal contents to bulge into the groin area, creating a hernia that may need surgical repair.

Psychological effects can develop if the condition isn't treated before school age. Children may feel self-conscious about their appearance, especially during activities like swimming or sports that involve changing clothes.

How can undescended testicle be prevented?

Unfortunately, there's no reliable way to prevent undescended testicles since the condition typically results from complex developmental processes during pregnancy. However, maintaining overall maternal health can support normal fetal development.

Taking prenatal vitamins and following your doctor's recommendations during pregnancy helps ensure optimal conditions for your baby's development. Folic acid, in particular, supports proper formation of reproductive organs.

Avoiding harmful substances like tobacco, alcohol, and recreational drugs during pregnancy reduces risks of various developmental problems. These substances can interfere with the hormonal signals that guide testicle descent.

Managing chronic conditions like diabetes before and during pregnancy helps create a healthier environment for fetal development. Well-controlled blood sugar levels reduce risks of many birth differences.

How is undescended testicle diagnosed?

Diagnosis typically begins with a physical examination by your child's pediatrician. The doctor will gently feel the scrotum and groin area to locate the testicle and determine its position.

Sometimes distinguishing between truly undescended testicles and retractile testicles requires careful examination. Retractile testicles can be gently guided into the scrotum and will stay there temporarily, while undescended ones cannot.

Imaging tests like ultrasound may be needed if the doctor can't locate the testicle during physical examination. These tests help determine whether the testicle is in the abdomen, groin, or possibly absent altogether.

In rare cases where imaging doesn't provide clear answers, laparoscopy might be recommended. This minimally invasive procedure uses a tiny camera to look inside the abdomen and locate the testicle.

Blood tests to measure hormone levels are sometimes helpful, especially if both testicles are undescended. These tests can reveal whether the testicles are producing hormones normally.

What is the treatment for undescended testicle?

Treatment approach depends on your child's age and the testicle's location. The goal is to move the testicle into its proper position in the scrotum before complications develop.

For babies under six months, doctors often recommend watchful waiting since testicles sometimes descend naturally during the first few months of life. Regular checkups monitor progress during this period.

Hormone therapy using injections of human chorionic gonadotropin (hCG) works in some cases, particularly when testicles are close to the scrotum. However, success rates vary and this approach isn't always effective.

Surgical treatment called orchiopexy becomes necessary when other approaches don't work. This procedure moves the testicle into the scrotum and secures it in proper position. Most surgeons recommend performing this surgery between 6-18 months of age.

For testicles located high in the abdomen, a two-stage surgical approach might be needed. The first surgery brings the testicle lower, and the second stage completes the move into the scrotum several months later.

In rare cases where the testicle is severely underdeveloped or absent, the surgeon might recommend removal and possible placement of a prosthetic testicle for cosmetic purposes when the child is older.

How to provide home care during undescended testicle treatment?

Before surgery, no special home care is typically needed since undescended testicles don't cause pain or immediate problems. Simply continue with normal bathing and diaper changing routines.

After orchiopexy surgery, keeping the incision area clean and dry helps prevent infection. Your surgeon will provide specific instructions about bathing and wound care during the healing period.

Pain management usually involves over-the-counter medications like acetaminophen or ibuprofen as recommended by your doctor. Most children experience only mild discomfort for a few days after surgery.

Activity restrictions may apply for several weeks after surgery to prevent strain on the surgical site. Your surgeon will advise when your child can return to normal activities like running, jumping, or riding bikes.

Watch for signs of complications like excessive swelling, redness, fever, or persistent pain. Contact your healthcare provider if you notice any concerning changes during the recovery period.

How should you prepare for your doctor appointment?

Write down any questions or concerns you have about your child's condition before the appointment. This helps ensure you don't forget important topics you want to discuss with the doctor.

Bring a list of any medications or supplements your child takes, even though most infants and toddlers aren't on regular medications. Also mention any allergies or previous reactions to medications or treatments.

Prepare to discuss your family history, particularly any relatives who had undescended testicles or other reproductive system issues. This information helps the doctor understand potential genetic factors.

Consider bringing your partner or a supportive family member to the appointment. Having another person present can help you remember important information and provide emotional support during discussions about treatment options.

Don't hesitate to ask about the surgeon's experience with orchiopexy if surgery is recommended. Inquire about success rates, potential complications, and what to expect during recovery.

What's the key takeaway about undescended testicle?

Undescended testicle is a common and treatable condition that affects many baby boys. While it requires medical attention, the outlook is excellent when properly managed with timely treatment.

Early detection and appropriate treatment prevent most long-term complications. Surgery is highly successful, with most children going on to have normal reproductive health and development.

Remember that having an undescended testicle doesn't reflect anything you did or didn't do during pregnancy. This condition results from complex developmental processes that sometimes don't complete as expected.

Trust your healthcare team and don't hesitate to ask questions about your child's care. Open communication ensures you understand the treatment plan and feel confident about the decisions being made.