Undescended Testis

During the unborn male’s development, the testicles (testes) are located in the abdomen and gradually move down into the scrotum during the seventh month of pregnancy. When they descend, they pass through a small passageway that runs along the abdomen near the groin called the inguinal canal. Once through the inguinal canal, the testes reside in the scrotal sac. Since the scrotal sac is cooler than the body temperature, it is the ideal location for the testicles because they function better at this cooler temperature. 

Undescended testis (testes – plural) and cryptorchidism refer to a condition in which the testicle has not descended and cannot be brought into the scrotum with external manipulation. This occurs in 3 percent of newborn males and up to 21 percent in premature male newborns. Most testes descend by 3-4 months of age. 

The undescended testis can be located in the abdomen, the inguinal canal or other more unusual locations, but most are located in the inguinal canal (80 percent). About 10 percent to 15 percent of all cases are bilateral (involve both testicles). 

There is a genetic association with this condition. About 14 percent of boys with this condition come from families in which another male is affected. Six percent of fathers of males with undescended testis have also had this problem. 

It is very important to clarify that “retractile testicles” are not undescended testicles. If a testicle can be brought down into the scrotal sac, even if it bounces back up again upon release, it is a retractile testis. These retractile testicles are in the scrotum at other times and do not require treatment.

The discovery of an undescended testicle can be made by parents or by a pediatrician during a physical examination. Often, no testicle can be felt; this condition is called a non-palpable testicle (unable to be felt on examination of the scrotal sac). Frequently, the exam shows an inguinal hernia (an opening in the lower abdominal wall or inguinal canal where the intestines may protrude) as well.

It is unknown why testicles fail to descend. It may be because the testicles were never normal at development, or that there was a mechanical problem that led the testicles in the wrong direction or that the infant’s hormones may have been insufficient to stimulate the testicles normally.

The undescended testicle does not cause pain. The scrotal sac may look smoother, smaller or more flat than the unaffected side.

If an undescended testicle is not corrected, the following complications may occur as the male child grows and matures:

Infertility

The exposure of the testicle to the higher temperature of the body, when it is not in the scrotum, may impair sperm production.

Malignancy

An undescended testicle increases the risk of testicular cancer in adulthood. While the correction of the undescended testicle does not decrease the risk of cancer, it allows for the testicle to be properly examined in the future and early detection of cancer if it develops. Even though the risk for cancer is increased, the risk is considered to be low.

Trauma

A testicle that is trapped in abnormal position is more likely to be injured from trauma during ordinary activity.

Testicular Torsion

Testicular torsion is a painful condition where the testicle can twist and decrease its blood supply and eventually lead to testicular loss. This can occur more often in an undescended testicle.

There are two treatment options: hormonal and surgical.

Hormonal

In cases in which both sides are undescended, hormonal treatment may aid the testicles’ descent into the scrotum. The hormone human chorionic gonadotropin (hCG) is given as an injection over several weeks. It cures undescended testes about 10 percent to 15 percent of the time. Surgery may still be indicated.

Surgery

There are several possible procedures to correct this condition depending upon the location of the testicle and the distance to the scrotal sac.

1. An orchidopexy is an outpatient (patient does not need to stay in hospital) procedure which requires general anesthesia. This is performed when the surgeon can palpate (feel) the testicle in the groin. A small incision (cut) is made in the groin (area where the leg attaches to the body); the testicle is located, freed from restrictive tissues, positioned and anchored in the scrotum. The passage way is then stitched closed to prevent re-ascent.

2. A laparoscopic orchidopexy procedure is frequently performed when the testicle is nonpalpable (cannot be felt on physical exam). The testicle may be located in the abdomen, may be absent or very small (atrophic). 

Occasionally, the testicle is too severely malformed to be saved. It may have twisted sometime prior to the child's birth and lost its blood supply. During surgery, the remaining non-functional tissue is removed. The other testicle is secured in its scrotal sac to prevent testicular torsion of that testicle. If the malformed testicle is removed, a prosthesis (an artificial replacement) can be placed in the scrotum after puberty.

3. A testicular auto-transplant is indicated when the testicle is located very high in the abdomen and the blood vessels and other necessary structures are neither ample nor elastic enough to be stretched to the scrotum. The testicle must be "auto-transplanted" into the scrotum with all the necessary blood vessels and structures first cut and then reconnected (anastomosed).

  • Inability to urinate after eight hours following surgery
  • Temperature of 101 degrees or above following surgery
  • A green or yellowish discharge from the suture lines along with increased redness, swelling and pain
  • Vomiting more than three times; inability to keep liquids down
  • Extreme pain, not relieved by pain medication

After-Surgery Care for the Orchidopexy and the Laparoscopic Orchidopexy

  • For pain control, over-the-counter Tylenol can be given every four hours, but do not exceed five doses in 24 hours. Patients that are at least 4 years old may be given a prescription for a stronger pain medicine. Use this prescription only for significant discomfort and administer as directed.
  • We advise the patient to receive pain medication on schedule for the first 24 to 48 hours after surgery. After that time, administer medicine only if needed.
  • Your surgeon will direct you on the care of the bandage / dressing and surgery site.
  • No tub baths for five days post-op; showering may be permitted. A sponge bath is OK.
  • For four weeks, do not place your child in an exercise saucer or a walker, and refrain from carrying the child across your hip bone. It is fine to place the child in a car seat and high chair. For the older child, avoid riding a bike, climbing a jungle gym or participating in gym class.
  • Your child may return to school or daycare when comfortable and not requiring prescription pain medicine, usually in two to five days.

After-surgery care for testicular auto-transplant will be given by the surgeon.


Last Updated 10/2012