Undescended testicle

Answer 1

Definition

Undescended testicle occurs when one or both testicles fail to move into the scrotum before birth.

Alternative Names

Cryptorchidism; Empty scrotum - undescended testes; Scrotum - empty (undescended testes); Monorchism; Vanished testes - undescended; Retractile testes

Causes, incidence, and risk factors

Undescended testicles are fairly common in premature infants. They occur in about 3 - 4% of full-term infants. In most cases the testicles descend by the time the child is 9 months old.

Once a testicle has been discovered in the scrotum, it is generally considered descended even if it is temporarily pulled back (retracted) on a later examination.

Sometimes a condition called retractile testes will develop. In this condition, the health care provider can sometimes locate the testicles and sometimes not.

This occurs because of the strength of the muscle reflex (cremasteric reflex) that retracts the testicles and the small size of the testicles before puberty. In this instance, the testicles descend at puberty. This is considered a type of normal. Surgical correction is not needed.

Testicles that do not descend by the time the child is 1 year old should be carefully evaluated. Studies suggest that surgery should be done by this age to confirm the diagnosis and to reduce the chances of permanent damage to the testicles.

Testicles that do not naturally descend into the scrotum are considered abnormal. These undescended testicles have an increased likelihood of developing cancer, regardless of whether or not they are brought down into the scrotum.

Bringing the testicle into the scrotum maximizes sperm production and increases the odds of good fertility. It also allows examination for early detection of testicular cancer.

In other cases, such as vanished testis, no testicle may be found, even during a surgical procedure. This may be due to a problem that occurs while the baby was still developing in the mother. It may be present at birth (congenital).

Symptoms

There are usually no symptoms, except that the testicle cannot be found in the scrotum (this may be described as an empty scrotum). Adult males with an undescended testicle may have problems with infertility.

Signs and tests

An examination confirms that one or both of the testicles are not in the scrotum.

The health care provider may or may not be able to feel the undescended testicle in the abdominal wall above the scrotum.

Treatment

Usually the testicle will descend into the scrotum without any intervention during the first year of life. If this does not occur, the child may receive hormone injections (B-HCG or testosterone) to try to bring the testicle into the scrotum.

Surgery (orchiopexy) is the main treatment. Earlier surgery may prevent irreversible damage to the testicles. This damage can cause infertility.

Expectations (prognosis)

Most cases get better on their own, without any treatment. Medical or surgical correction of the condition is usually successful.

About 5% of patients with undescended testicles do not have testicles that can be found at the time of surgery. This is called a vanished or absent testis.

Complications

If one or both testicles do not descend, a man may be infertile later in life. Men who have an undescended testicle at birth are at higher risk of developing testicular cancer in both testes. Surgery to correct the problem may result in damage to the testicle.

Calling your health care provider

Call your child's health care provider if he appears to have an undescended testicle.

Call your provider if you are a male, 15 years or older and you are unsure how to perform testicular self-examination(TSE) to screen for testicular cancer.

References

Schneck FX, Bellinger MF. Abnormalities of the testes and scrotum and their surgical management. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 127.

Elder JS. Disorders and anomalies of the scrotal contents. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 545.

Answer 2

Definition

Undescended testicle occurs when one or both testicles fail to move into the scrotum before birth.

Alternative Names

Cryptorchidism; Empty scrotum - undescended testes; Scrotum - empty (undescended testes); Monorchism; Vanished testes - undescended; Retractile testes

Causes, incidence, and risk factors

Most of the time, children's testicles descend by the time they are 9 months old. Undescended testicles are fairly common in infants who are born early (premature infants). It occurs in about 3 - 4% of full-term infants.

Once a testicle has been found in the scrotum, it is considered descended, even if it is temporarily pulled back (retracted) during a later examination.

Some babies have a condition called retractile testes, in which the health care provider sometimes cannot find the testicles. This is due to the muscle reflex that retracts the testicles and the small testicle size before puberty. The testicles will descend at puberty. Surgery is not needed.

Testicles that do not descend by the time the child is 1 year old should be evaluated. Studies suggest that surgery should be done by this age. Surgery can reduce the chances of permanent damage to the testicles, which can lead to fertility problems later in life.

Testicles that do not naturally descend into the scrotum are considered abnormal. An undescended testicle is more likely to develop cancer, even if it is brought down into the scrotum. The other testicle is also more likely to develop cancer, even if it descended properly.

Bringing the testicle into the scrotum improves sperm production and increases the odds of good fertility. It also allows the health care provider to examine the testicle to detect cancer early.

In other cases, no testicle may be found, even during surgery. This may be due to a problem that occured while the baby was still developing in the mother (congenital).

Symptoms

There are usually no symptoms, except that the testicle cannot be found in the scrotum (this may be described as an empty scrotum).

Signs and tests

An examination confirms that one or both of the testicles are not in the scrotum.

The health care provider may or may not be able to feel the undescended testicle in the abdominal wall above the scrotum.

Treatment

Usually the testicle will descend into the scrotum without treatment during the child's first year of life. If this does not occur, the child may get hormone injections (B-HCG or testosterone) to try to bring the testicle into the scrotum.

Surgery (orchiopexy) to bring the testicle into the scrotum is the main treatment. Having surgery early may prevent damage to the testicles that can cause infertility.

If the undescended testicle is found later in life, the health care provider may recommend removing it, because it will not work very well and it could develop cancer.

Expectations (prognosis)

Most cases get better on their own, without any treatment. Medicine or surgery to correct the condition is usually successful.

In about 5% of patients with undescended testicles, the testicles cannot be found at the time of surgery. This is called a vanished or absent testis.

Complications

• Damage to the testicle from surgeryInfertility later in life
• Testicular cancer in both testes

Calling your health care provider

Call your child's health care provider if he appears to have an undescended testicle.

References

Schneck FX, Bellinger MF. Abnormalities of the testes and scrotum and their surgical management. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 127.

Elder JS. Disorders and anomalies of the scrotal contents. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 539.

Wampler SM, Llanes M. Common scrotal and testicular problems. Prim Care. 2010; 37:613-626.

Reviewed By

Review Date: 09/16/2011

Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; Scott Miller, MD, Urologist in private practice in Atlanta, Georgia. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.