As a baby boy grows inside his mother's womb, his testicles
typically form inside his abdomen and move down (descend) into the
scrotum shortly before birth. But in some cases, that move or
descent doesn't occur, and the baby is born with a condition
known as undescended testicles (or cryptorchidism).
Cryptorchidism is the most common genital abnormality in boys,
affecting approximately 30% of baby boys born prematurely and about
4% born at term.
In about half of the babies, the undescended testicles move down
or descend on their own by the sixth month of life. If spontaneous
descent doesn't happen by then, it's important to get
treatment because testicles that remain undescended may be damaged,
which could affect fertility later or lead to other medical
problems.
Diagnosis
Doctors usually diagnose cryptorchidism during a physical exam
at birth or at a checkup shortly after. In 7 of 10 boys with an
undescended testicle (or "testis"), it can be located or
"palpated" on examination by the pediatric specialist. In
3 of 10 boys, the testicle may not be in a location where it can be
located or palpated, and may appear to be missing. In some of these
cases, the testicle could be inside the abdomen. In some boys with
a "non-palpable" testicle, however, the testicle may not
be present because it was lost while the baby was inside the
womb.
In some boys, the testicles (or "testes") may appear
to be outside of the scrotum from time to time, which can raise the
concern of an undescended testicle. Some of these boys may have the
condition known as retractile testes. This is a normal condition in
which the testes reside in the scrotum but on occasion temporarily
retract or pull back up into the groin. There is no need to treat a
retractile testicle, since it is a normal condition, but it may
require examination by a pediatric specialist to distinguish it
from an undescended testicle.
Treatment
If a baby's testicle has not descended on its own within the
first 6 months of life, the boy should undergo evaluation by a
pediatric specialist and treatment if the condition is confirmed.
This usually involves surgically repositioning the testicle into
the scrotum.
Treatment is necessary for several reasons:
- The higher temperature of the body may inhibit the normal
development of the testicle, which could impair normal production
of sperm in the undescended testicle in the future, which could
lead to infertility.
- The undescended testicle is at a greater risk to form a tumor
than the normally descended testicle.
- The undescended testicle may be more vulnerable to injury or
testicular torsion.
- An asymmetrical or empty scrotum may cause a child worry and
embarrassment.
- Sometimes boys with undescended testicles develop inguinal
hernias.
If surgery is done, it's likely that doctors will perform an
orchiopexy, in which a small cut is made in the groin and the
testicle is brought down into the scrotum where it is fixed (or
pexed) in place. Doctors typically do this on an outpatient basis,
and most boys recover fully within a week.
Most doctors believe that boys who've had a single
undescended testicle will have normal fertility potential and
testicular function as adults, while those who've had two
undescended testicles may be more likely to experience diminished
fertility as adults. It is recommended that all boys who've had
undescended testicles undergo follow-up evaluations by a urologist
for years after their corrective surgeries.
It is important for all boys - even those whose testicles have
properly descended - to learn how to do a testicular self-exam when
they are teenagers so that they can detect any lumps or bumps that
might be early signs of medical problems.
Reviewed by:
T. Ernesto Figueroa, MD
Date reviewed: June 2008
Note: All information is for educational purposes only. For specific medical advice,
diagnoses, and treatment, consult your doctor.
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