Undescended Testes (Testicles; also Cryptorchidism)

In undescended testes (UDT, or cryptorchidism), a baby boy’s testes do not descend properly to the scrotum. In normal fetal development, the testes (or testicles) first appear in the baby boy's abdomen at approximately the level of the kidney. Then they begin to descend toward the scrotum, where they typically "arrive" by 36–38 weeks. But in UDT, the descent is somehow blocked.

Sometimes UDT is seen with other anomalies, especially those involving the anus and rectum or the genital and urinary tracts.

UDT appears in about 1% of males and is also more commonly seen in premature infants than in those who are full term. It is also associated with hormonal disorders, spina bifida and other abnormalities present at birth.

What Are the Symptoms of Undescended Testes?

Finding an empty scrotum and an inguinal lump are obvious signs. The undescended testis is located in the inguinal canal in approximately 80% of cases, but can also be found within the abdominal cavity or in another location. Ten percent of cases involve both testes.

Furthermore, the testes cannot be brought into the scrotum with external manipulation. This makes it important to know if the testis was seen or felt in the scrotum at any time. The diagnosis of UDT is ruled out if the testes can manually be brought down into the scrotum.

The examination must be performed in a comfortable and warm environment. Visual inspection is particularly helpful, since sometimes even touching the child's lower abdomen, upper thighs or genitalia may cause the testes to retract out of the scrotum.

How Are Undescended Testes Treated?

Unless both testes are absent, UDT usually can be addressed when the baby has passed his first birthday. However, if the child needs surgery for a hernia repair, which also occurs in many cases, the UDT should be corrected at the time of the hernia surgery. Definitive correction of UDT is best done between 1- to -2-years-old. By that time, delayed descent can be noted, precise examination is easier to perform and a period of observation by parents and pediatricians will determine that the problem is UDT rather than retractile testis. Delay beyond 2-years-old is not recommended.

What Are the Long-Term Effects of Undescended Testes?

In most cases, the procedure has excellent results. Fertility after surgery for UDT is 95%, but only 70% for bilateral (involving both testes) UDT. The risk of testicular malignancy in patients with a history of cryptorchidism is five to 10 times greater than the normal population. The risk is greater for bilateral cryptorchidism and intra-abdominal testes.

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