Undescended testicles, also known as cryptorchidism, is a fairly common congenital condition that affects about 1 in every 25 newborn males. The condition occurs when one or both of a baby’s testicles fail to descend into the scrotum from the abdomen during fetal development. Oftentimes, only one testicle is affected, and most cases will resolve on their own within a few months. However, if the testicles don’t eventually descend into normal positioning, medical intervention may be required. Therefore, it’s important to be aware of this condition and its potential complications to ensure that your child receives the right treatment. Here, we’ll discuss everything you need to know about undescended testicles.
What Happens Under Normal Testicular Development?
Under normal testicular development, the testicles (testes) form in your baby’s abdomen and begin to descend towards the scrotum during the third trimester. During fetal development, the testes are held in place by several structures, including the gubernaculum. This is a cord-like structure that extends from the testes to the bottom of the scrotum. As the testes descend, they pull the gubernaculum with them, and the testes “drop” either shortly before or after birth.
Once the testes have descended into the scrotum, they continue to develop and mature. The scrotum provides an environment that is cooler than the body's core temperature, which is necessary for proper sperm production. The testes also produce testosterone, a hormone that is responsible for the development of male characteristics, such as facial hair, a deeper voice, and increased muscle mass.
Normal testicular development is essential for proper male reproductive function and overall health. Any disruptions in this process, such as cryptorchidism, can potentially cause complications and require additional treatment methods.
Symptoms of Undescended Testicles
The most obvious symptom of undescended testicles is the absence of one or both testicles from the scrotum. However, this might not be visibly obvious, as the scrotum is still present. You may notice a smaller scrotum or one that appears asymmetrical, and, in some cases, undescended testicles can cause an inguinal hernia. After birth, doctors will check for signs or symptoms of undescended testicles and if they cannot be felt, they’re likely still in the groin or abdomen.
It's important to note that not all cases of undescended testicles are immediately apparent, and some cases may not be diagnosed until later in life. This is called acquired undescended testes and can occur anywhere between one and 10 years of age. It’s often caused by delayed growth of the spermatic cord, which pulls the testes back into the groin. During diaper changes, check your child’s scrotum and attend regular checkups with your pediatrician to ensure that any issues are identified and addressed in a timely manner.
What Are Retractile Testes
Although acquired undescended testes can occur during your child’s development, it’s not the same as a condition called retractile testes or retracted testicles. This is a condition where one or both testicles may temporarily move up into the groin area. Retractile testes are caused by a reflex that develops after six months, where the body pulls the testicles up for protection. It can be triggered by cold temperature or fear. They then return to their normal position in the scrotum naturally.
What Are Ectopic Testes?
An ectopic testicle is a rare condition in which a testicle develops outside of its normal location. Instead of the scrotum, the testicle may be found in other areas of the body, such as the thigh, the perineum (the area between the scrotum and anus), or even the opposite side of the body. Treatment is recommended to avoid long-term complications. Oftentimes, this includes surgically repositioning the testicle to its normal location or removing it completely.
When to See a Doctor for Cryptorchidism
Most cases of undescended testicles are noticed quickly when your baby is examined after delivery. However, if you notice signs that may indicate acquired undescended testes later in life, seeing your child’s pediatrician or a pediatric urologist as soon as possible is the best way to ensure that you receive the proper diagnosis and treatment plan.
What Causes an Undescended Testicle?
The exact cause of cryptorchidism isn’t fully understood, but it seems to be related to a combination of environmental and genetic factors. Some doctors believe that hormone disruptions or imbalances during development may interfere with the normal descent of the testicles. The proper development and descent of the testicles is regulated by a delicate balance of hormones, including testosterone and gonadotropin-releasing hormone (GnRH). There are also several factors that may increase the risk of your child experiencing cryptorchidism, which include the following:
- Low birth weight
- Family history of cryptorchidism
- Abdominal wall defects
- Down syndrome
- Klinefelter syndrome
- Alcohol use
- Substance use
- Premature birth
- Smoking
- Exposure to pesticides or other chemicals
By identifying potential risk factors and addressing them early in your pregnancy, you can reduce the likelihood of this congenital condition. However, even if your child experiences undescended testicles, early diagnosis and treatment can help minimize potential complications and ensure optimal reproductive and overall health.
Complications of Untreated Cryptorchidism
Since testes need to be cooler than the body’s temperature to properly function, untreated cryptorchidism can lead to long-term complications. Some of the biggest risks of undescended testicles include the following:
Infertility
One of the most significant complications of untreated cryptorchidism is infertility. Undescended testicles can lead to impaired sperm production such as low sperm count and poor sperm quality. This, in turn, can make it difficult or impossible to father a child. The longer the condition is left untreated, the more it can impact sperm production.
Testicular Cancer
Men with a history of undescended testicles are also at an increased risk of developing testicular cancer. This is much more likely if the condition is left untreated, the undescended testicle is in the abdomen rather than the groin, and if both testes are affected. This is one of the reasons early treatment is so important.
Testicular Torsion
Boys who experience undescended testicles are also at an increased risk of testicular twisting or testicular torsion. This occurs when the spermatic cord is twisted, which can cut off the blood supply and cause severe pain or damage to the testicle. Testicular torsion needs to be treated as soon as possible.
Inguinal Hernia
In some cases, undescended testicles can lead to an inguinal hernia, which is a protrusion of the intestine or abdominal tissue into the groin area.
It's important to note that the risk of these complications can be significantly reduced with early diagnosis and treatment. Always call your pediatrician if you suspect an issue or notice any troublesome signs or symptoms.
Treatment for Undescended Testicles
The treatment options for undescended testicles tend to depend on the age of the patient and the severity of the condition. Some of the most common treatment options include the following:
Observation
If your newborn has undescended testicles and is under three months old, your doctor may recommend observation. In some cases, undescended testicles will correct themselves and descend into the scrotum on their own during the first few months of life. However, if they haven’t dropped by four months, it’s unlikely they will without medical intervention.
Hormone Therapy
Hormone therapy involves the use of medications, such as human chorionic gonadotropin (hCG) or gonadotropin-releasing hormone (GnRH), to stimulate testicular descent. Hormone therapy is typically used in infants with mild cases of undescended testicles but is usually not as effective as surgery.
Surgery
Surgery is the most common and most effective treatment for undescended testicles. During the procedure, a surgeon will move the testicle(s) into the scrotum through a small incision. The surgery is typically performed under general anesthesia and can be done on an outpatient basis. In some cases, a second surgery may be required if the testicle(s) do not descend fully or if there are other complications.
It's important to note that treatment for undescended testicles is typically recommended before 18 months of age, as delaying treatment can increase the risk of complications. Regular follow-up visits with a urologist are also important to monitor the condition and ensure that the testicles are functioning properly.
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