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Undescended Testes (Cryptorchidism)

What is cryptorchidism (undescended testes)?

Cryptorchidism (or undescended testes) is a condition seen in newborns when one or both of the testes have not passed down into the scrotal sac. Thirty percent of cases are bilateral (involve both testes). Cryptorchidism is more commonly seen in premature males because the testes do not descend from the abdomen to the scrotal sac until the seventh month of fetal development.

What causes undescended testes?

It is not always clear why the testes do not complete their normal descent. Sometimes it is part of a syndrome or associated with a hormonal disorder but most often is occurs in otherwise healthy normal children for reasons that are not well understood.

Who is affected by undescended testes?

  • Undescended testes occur in approximately 3 percent of male infants.
  • 21 percent of premature male infants have an undescended testis.
  • Undescended testes occurs in 3 percent to 4 percent of full-term infants.
  • There is also a genetic component: 6 percent of fathers of males with undescended testes also had the condition.
  • In rare cases, boys who undergo an inguinal hernia repair may develop undescended testes.

What are the symptoms of undescended testes?

There are no symptoms of undescended testis unless a hernia or torsion occur.

How are undescended testes diagnosed?

Diagnosis of undescended testes is made based physical examination by parents and/or medical caregivers.

Treatment for undescended testes:

Undescended testes may descend without any intervention by the time the infant is 6 months old. Resolution occurs as the testicles (or testes) descend through the inguinal canal (a small internal passageway that runs along the abdomen near the groin) into the scrotal sac. If the testicles (or testes) have not descended by 6 months of age, the testicles may not descend at all.

Specific treatment for undescended testes will be determined by your child's physician based on:

  • Your child's age, overall health, and medical history
  • The extent of the condition
  • Your child's tolerance for specific medications, procedures, or therapies
  • Expectations for the course of the condition
  • your opinion or preference

Treatment may include:

  • Hormonal therapy—administration of certain hormones may stimulate the production of testosterone, which helps the testes descend into the scrotal sac. This is not routinely used for treatment of truly undescended testes.
  • Surgical repair—a surgical repair to locate the undescended testicle and advance it to the scrotal sac may be recommended by your child's physician. This surgery, called orchiopexy, is usually performed between months 6 and 18 and is successful in 98 percent of children with this condition
  • Removal of the testis—if the testis is abnormally developed and/or too high in the abdomen to reach the scrotum it may be best to remove it. This is because it probably will not function normally and may still have some risk of developing a tumor (cancer)

If cryptorchidism is not repaired, the following complications may occur as your child grows and matures:

  • Infertility (most common in bilateral cases, where both testes are affected)
  • The undescended testis has an increased risk of developing cancer
  • Inguinal hernia (a weakened area in the lower abdominal wall or inguinal canal where intestines may protrude)
  • Testicular torsion (a painful twisting of the testes that can decrease blood supply to the testes)
  • Psychological consequences of an empty scrotum