UNDESCENDED TESTICLE

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An undescended testicle, also known as cryptorchidism, occurs when one or both testicles fail to move down into the sac of skin (scrotum) below the penis before birth. This is more common in premature babies but usually resolves on its own within a few months. If not, surgery can effectively move the testicle to its proper place.

During the final months of pregnancy, a baby undergoes significant changes. Their eyes widen, their bones complete formation, and they gain weight rapidly. For baby boys, this period also marks the time when the testicles usually descend from the lower belly into the scrotum, the pouch of skin below the penis.

However, in some cases, one or both testicles fail to descend, a condition known as an undescended testicle. While this can occur in any baby boy, it’s more common in those born prematurely.

Typically, a testicle moves into the scrotum on its own by the time the baby reaches 6 months of age. If it doesn’t, surgical intervention is often necessary.

Why is this important?

The scrotum keeps the testicles slightly cooler than body temperature, which is crucial for proper development and function. An undescended testicle can lead to complications like:

• Testicular cancer: Men with undescended testicles have a higher risk, especially those located in the abdomen.
• Fertility problems: Undescended testicles can affect sperm production.
• Testicular torsion: a painful twisting of the cord supplying blood to the testicle.
• Inguinal hernia: when part of the intestine pushes through a weak spot in the abdominal wall.

What are the causes?

Doctors don’t fully understand the exact cause of an undescended testicle. However, they believe it may be linked to genetic factors, the mother’s health, and external influences that disrupt normal hormone and nerve functions.

Risk factors

Although the precise cause remains uncertain, several factors may increase the likelihood of an undescended testicle:

1. Premature birth
2. Family history of similar conditions or genital developmental issues
3. Health conditions affecting fetal growth, such as Down syndrome
4. Low birth weight
5. Exposure to certain chemicals, like pesticides, which are commonly used in farming

Additionally, certain maternal factors may contribute to the likelihood of this condition, such as:

1. Diabetes (type 1, type 2, or gestational)
2. Obesity
3. Smoking cigarettes or consuming alcohol during pregnancy

Detecting an undescended testicle can be straightforward. The primary sign is the inability to see or feel the testicle within the scrotum. When both testicles are undescended, the scrotum may appear flat and smaller than expected.

Some boys may have what’s known as a retractile testicle, which can move up into the groin when they are cold or frightened but returns to its usual position on its own. This typically isn’t a cause for concern. The key distinction is that an undescended testicle remains in the groin area without moving back and forth.

How is it diagnosed?

Diagnosing an undescended testicle usually occurs during routine check-ups soon after birth. If your doctor suspects an issue, they may first rule out other conditions, like ectopic testicles, through a physical examination.

Ectopic testicles share similarities with undescended testicles, but they also remain misplaced. By gently attempting to move the testicle into the scrotum, doctors can differentiate between an undescended testicle and a retractile one.

Complications of undescended testicle

An undescended testicle can lead to various complications.

1. Fertility Problems: Sperm production requires a slightly cooler environment than the body’s core temperature. When testicles remain in the groin, fertility issues may arise, especially if both testicles are affected. Early intervention through surgery can significantly improve fertility prospects.
2. Hernia: There’s a risk of hernia, where a portion of the intestine protrudes through the lower abdominal muscles.
3. Injury: Testicles that are out of position are more susceptible to damage.
4. Cancer: Men with undescended testicles face a slightly elevated risk of testicular cancer, even after surgical correction. However, surgery enables routine self-examinations, facilitating early detection and treatment if cancer develops.
5. Testicular Torsion: This painful condition occurs when the spermatic cord twists, potentially cutting off blood flow to the testicle.

Treatment options

Surgery (orchiopexy) is the most common treatment. It is highly effective and usually performed between 6 to 12 months of age to maximize benefits. During the procedure, the baby receives medication to ensure they are comfortable and pain-free. The surgeon locates the testicle through a small incision in the groin or lower abdomen, gently guides it into the scrotum, and secures it in place with stitches. The incisions are then closed with dissolvable stitches.

Following surgery, most babies can return home the same day. Pain medication may be prescribed for a few days, and caregivers should keep the area dry and prevent irritation, such as from rough play or ride-on toys.

In some cases, hormone treatment might be attempted, but it’s less effective and less common with potential side effects. Therefore, surgery remains the preferred option for correcting undescended testicles.If the testicle is damaged or dead tissue, it may be removed.

What to expect after surgery

Most surgeries are successful, with a high chance of normal testicle development and fertility. Regular checkups and self-exams after puberty are important for monitoring any changes.

Coping and support:

Children with undescended testicles might feel self-conscious. Talk to them openly about their condition and explain that it’s treatable and doesn’t affect their overall health. Consider testicular prostheses for cosmetic reasons and discuss self-examination techniques for early detection of any abnormalities.

By understanding the risks and treatment options, you can ensure your child receives the care they need for healthy development.

Sources

These sources include Mayo Clinic, Urology Care Foundation, NHS, Johns Hopkins Medicine, Cleveland Clinic, Boston Children’s Hospital, The American Pediatric Surgical Association Family and Parent Resource Center, Kids Health, American Family Physician, Winchester Hospital, Children’s Hospital of Pittsburgh, and WakeMed Health and Hospitals.