Understanding Undescended Testicles in Children

Undescended testicles, also known as cryptorchidism, is a common condition where one or both of a baby boy’s testicles do not descend into the scrotum before birth. While this may sound concerning, it is treatable. And most children who are diagnosed with the condition will grow up healthy if given the proper care.

This article explains what undescended testicles are, what causes them, how they are treated and what parents should know about the condition.

What Are Undescended Testicles?

In a typical pregnancy, a baby’s testicles form inside the abdomen and then descend into the scrotum before birth. However, in some cases, one or both testicles do not move into the scrotum as they should. When this happens, the condition is called undescended testicles.

Undescended testicles are more common in premature babies, but the condition can also occur in babies born at full term. It is usually detected during a routine physical exam shortly after birth. In many cases, the testicle may move into the scrotum on its own within the first few months of life. If the testicle does not descend, medical treatment may be necessary.

Causes of Undescended Testicles

The exact cause of undescended testicles is not always clear, but several factors can increase the risk:

• Prematurity: Babies born early are more likely to have undescended testicles because they have not had enough time in the womb for the testicles to descend.
• Hormonal Imbalances: Hormones play a key role in the development and descent of the testicles. Problems with hormone production or function can affect this process.
• Family History: Boys who have a family member, such as a father or older brother, with undescended testicles may have a higher risk of developing the condition.
• Maternal Health: Conditions such as maternal diabetes or obesity may increase the risk of undescended testicles.

Symptoms and Diagnosis

The main sign of undescended testicles is the absence of one or both testicles in the scrotum. A doctor will typically notice this during a newborn’s physical exam. If a testicle is not easily felt in the scrotum, the doctor may use imaging tests such as an ultrasound to locate it.

In many cases, the testicle will descend naturally within the first few months after birth. However, if the testicle does not move into the scrotum by six months of age, further evaluation and treatment may be needed.

Why Is Treatment Important?

While undescended testicles may not cause immediate harm, the condition can lead to complications if left untreated:

• Fertility Issues: Testicles are designed to function best at the cooler temperature of the scrotum. When a testicle stays in the abdomen or groin, the higher temperature can affect its ability to produce sperm, which could lead to infertility later in life.
• Testicular Cancer: Boys with undescended testicles have a slightly higher risk of developing testicular cancer in adulthood, though this risk is still relatively low. Early treatment can reduce this risk.
• Inguinal Hernia: Children with undescended testicles are more likely to develop an inguinal hernia, a condition where a part of the intestine pushes through the abdominal wall.
• Testicular Torsion: Testicular torsion, which occurs when the testicle twists and cuts off its blood supply, is a serious condition that can cause pain and may require emergency surgery.

Treatment Options

1. Observation

In many cases, especially for full-term babies, doctors will wait until the baby is about 6 months old to see if the testicle descends on its own. About 80% of cases resolve naturally by this time.

2. Hormonal Therapy

Sometimes, doctors may try hormonal treatment, such as human chorionic gonadotropin (HCG), to help the testicle descend. However, this treatment is not always effective and is used less often than surgery.

3. Surgery (Orchidopexy)

If the testicle has not descended by the time the baby is six to 12 months old, surgery is usually recommended. The procedure, known as orchiopexy, involves moving the undescended testicle into the scrotum and securing it in place. The surgery is typically done under general anesthesia and is considered safe and effective.

The procedure is usually performed as an outpatient procedure, meaning the child can go home the same day. Most children recover quickly and are able to return to normal activities within a few weeks.

After Surgery

Recovery from this surgery is generally quick. Children may experience some swelling or discomfort in the scrotum for a few days, but this usually improves within a week. Doctors typically recommend avoiding strenuous activity or sports for a few weeks after the surgery to allow time for healing.

Follow-up appointments will be scheduled to ensure the testicle remains in the correct position and there are no complications.

When to Seek Medical Attention

Parents should talk to their doctor if their child’s testicle has not descended by six months of age, or if there are any concerns about pain, swelling or changes in the groin area. If surgery is needed, it is important to address the condition before the child is 1 to avoid complications such as infertility or an increased risk of testicular cancer.

Conclusion

Undescended testicles are a common condition that can usually be treated effectively. While many cases resolve on their own, if the condition persists, it is important to seek medical advice to prevent future health problems. With early treatment, most children with undescended testicles go on to lead normal, healthy lives. Parents should work closely with their healthcare team to ensure the best outcome for their child.