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 to 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 may be associated with hormonal disorders, spina bifida, and other abnormalities present at birth.  

Lurie Children’s nationally ranked Division of Urology experts are uniquely qualified to treat these conditions. 

What Are the Symptoms of Undescended Testes?

Finding an empty scrotum and a lump in the groin is generally a clear sign of an UDT. The undescended testis is located in the groin in approximately 80% of cases but can also be found within the abdominal cavity or in another location. If located in the abdominal cavitiy, the testicle may not be able to be felt. 10% of cases involve both testes. 

How Are Undescended Testes Treated?

• Physical examination: This is the first step in diagnosing undescended testes. The doctor will examine the baby's scrotum and groin area to feel for the testicles. If the testicles are felt outside of the scrotum or not felt at all, they may be undescended. 
• Other tests: In some cases, other tests, such as blood tests or hormonal tests, may be needed to rule out other medical conditions that could be causing the undescended testes. 

Why are Undescended Testes Treated? 

Testicles that develop outside of the scrotum are at risk for abnormal development. With abnormal development, there is a risk of decreased testicular function which can lead to infertility (difficulty having babies). Boys with UDT are also at increased risk for malignancy, especially if the UDT is not corrected. Correction of UDT prior to puberty decreases these risks. 

The goals of surgical repair are to: 

1. Maximize fertility potential 
2. Decrease risk of testicular cancer  
3. Place the testicle in a location where routine self-testicular exams can be performed to detect any abnormalities  

How Are Undescended Testes Treated? 

If the testis has not reached the scrotum by 6 months of age, and the diagnosis of UDT has been clearly made, surgical correction is required. Surgery for correction of the UDT testicle is recommended between 6 and 18-months of age. Medications to help the testicle descend further into the scrotum are not recommended.

What is Surgery for Undescended Testes Like? 

The surgery for undescended testes, called orchiopexy, involves repositioning the testicles into the scrotum. 

The specific details of the surgery will vary depending on the circumstances, but here's a general overview: 

Before the Surgery

• Your child will undergo pre-operative assessments with a physical examination. Blood tests are generally not required. 
• You will discuss the procedure and any potential risks and benefits with the doctor. 
• Your child will need to fast for several hours before the surgery. 

During the Surgery

• The surgery is performed under general anesthesia, meaning your child will be asleep and unaware of the procedure.  
• The type of surgery that is performed will depend on the location of the testicle. For testicles that are in the groin, a small incision (~2cm) will be made in the groin to locate the testicle and bring it into the scrotum. An additional incision will be located in the scrotum. 
• When the testicle is in the abdominal cavity, a minimally invasive procedure (laparoscopic surgery) may be required to successfully move the testicle into the scrotum. Small incisions are made in the abdomen to allow the surgeon to insert a camera and surgical instruments to perform the surgery. 
• The surgery usually takes 1-2 hours, depending on the complexity.  

After the Surgery

• In most cases, your child will do home from the recovery room on the day of surgery.
• They will experience some pain and discomfort, which can be managed with pain medications like Tylenol and Motrin. 
• There will be restrictions on strenuous activity for a short period to allow for healing. Stiches will be required, but stitches dissolve on their own and do not require removal.  
• Follow-up appointments will be scheduled to monitor progress and ensure proper healing. 

What Are the Long-Term Effects of Undescended Testes? 

In most cases, the procedure has excellent results. Fertility rate after surgery for a single UDT is around 90%. This rate of successful fertility in lower in children with an UDT on both sides (~80%) The risk of testicular malignancy in patients with a history of UDT is five to 10 times greater than the general population with descended testes. The risk is greater for UDT on both sides and for those with  intra-abdominal testes. Correction of the UDT prior to puberty helps to decrease the risk of cancer.