Undescended testicle, sometimes called cryptorchidism, is a common problem in young males. It occurs when the testicle fails to descend from the abdomen, where it develops in an unborn male, to the scrotum within approximately six months of the baby’s birth.
UPMC’s urology team offers a full range of treatment options for an undescended testicle in children and adults, with the goals of preserving fertility, reducing testicular cancer risk, and repairing related hernias to lower the risk of complications.
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What Is an Undescended Testicle?
Undescended testicle, sometimes called cryptorchidism, is a common problem in young males. It occurs when the testicle fails to descend from the abdomen, where it develops in an unborn male, to the scrotum within approximately six months of the baby’s birth.
How serious is an undescended testicle?
An undescended testicle is not life-threatening. However, if left untreated, it can affect fertility, increase testicular cancer risk, and cause other complications.
What are the types of undescended testicles?
There are two types of undescended testicles, including:
- Ectopic testicles — Testicles that get stuck in an abnormal position and do not follow the normal path of descent.
- True undescended testicles — Undescended testicles that get stuck in the abdomen or groin along the normal path of descent.
How common is an undescended testicle?
An undescended testicle is a common condition, particularly among premature males. Up to 30% of premature males, 5% of males born at term, and 1% of one-year-old males will have an undescended testicle.
What causes an undescended testicle?
The testicle initially forms in an unborn male’s abdominal cavity. Near the end of pregnancy, the testicles descend to the scrotum.
If the process is incomplete, the testicle or testis might end up anywhere from inside the abdomen to just above the scrotum. Sometimes, the testis tries to descend but follows the wrong path and ends up in an abnormal (ectopic) location, usually not far from the scrotum.
Undescended testicle risk factors
Being born prematurely is the most significant risk factor for having undescended testicles.
Complications of an undescended testicle
Most undescended testicles diagnosed in newborns will come down to the scrotum during the first year of life, usually within three or four months of birth. If the testicle does not descend in the first year of life and is left untreated, it can cause complications later in life, including:
Infertility
Testicles are in the scrotum because this location is cooler than other places in the body. This minor temperature difference may have a dramatic influence on the ability of the testicles to make sperm, which are needed for fertility.
It has been shown that the testicles begin losing the cells that produce sperm early in life if they are not located in the scrotum. This process likely starts by one year of age. Bringing the testicle into the scrotum within the first year might preserve these cells and, therefore, improve chances of fertility in the future.
Increased risk of testicular cancer
Undescended testicles have a higher risk of developing testicular cancer than those that descend spontaneously. The overall risk of cancer is about 1 in 2,500, but this is still higher than the general population. Bringing the testis into the scrotum allows for more accurate examination — both by doctors and by the young men themselves — and, therefore, will result in earlier detection of testicular tumors if they occur.
Hernias
Undescended testicles are almost always associated with hernias. A hernia forms as a path for the testis to follow. If the testis does not descend completely, the hernia does not close and carries the same risks as any other hernia in the groin (inguinal hernia).
How can I prevent an undescended testicle?
There is nothing you can do to prevent an undescended testicle.
What Are the Signs and Symptoms of an Undescended Testicle?
Other than the testicle missing from the scrotum — called an empty scrotum — an undescended testicle doesn’t usually cause any symptoms.
When should I see a doctor about undescended testicle symptoms?
In most cases, your child’s doctor will notice an empty scrotum shortly after birth. If you notice that your child’s testicle is missing from their scrotum, you should schedule an appointment with their pediatrician.
How Do You Diagnose an Undescended Testicle?
An undescended testicle is typically diagnosed during a physical exam. Your doctor may also examine your child's abdomen to see if they can feel the undescended testicle.
Tests to diagnose an undescended testicle
Your doctor may order imaging tests to diagnose an undescended testicle, including:
- CT scan — A test that creates images of the body's organs, bones, and tissues.
- Ultrasound — Uses sound waves to create images of the organs to check for problems.
Undescended testicle prognosis
In some cases, an undescended testicle in the groin may move into the scrotum over time without treatment. However, medication or surgery might be necessary. Due to the increased risk of testicular cancer, males with undescended testicles need to have routine testicular exams throughout their lives.
How Do You Treat an Undescended Testicle?
The goals of undescended testicle treatment are to preserve fertility, reduce testicular cancer risk, and repair related hernias to lower the risk of complications.
Is surgery necessary for an undescended testicle?
If a newborn is diagnosed with an undescended testicle, the condition may correct itself within the first year of life. Your doctor may recommend monitoring the testicle’s position or using hormone therapy to help the testicle move into place. Surgery is not typically recommended for older adults with an undescended testicle.
If treatment is needed, options may include:
Treatment options for testicles that can be felt in the groin
Hormone treatment for an undescended testicle
Hormonal treatment with HCG involves a series of injections that stimulates the testicles to make hormones. In a small number of males, this treatment results in the testicle's permanent descent. Hormonal treatment is sometimes recommended if the testicle is very close to the scrotum and there is a good chance that it will successfully move into the proper position.
Surgery for an undescended testicle
If your doctor can feel the testicle in the groin area, they may recommend an operation called an orchiopexy. This surgery is almost always performed as an outpatient procedure. It is done through a small hernia incision in the groin and takes an hour and a half or less to perform. Recovery is usually quick with successful outcomes.
Laparoscopic orchiopexy
UPMC experts have been developing and refining the technique of laparoscopic orchiopexy, which has proven to be a safe and effective method for bringing undescended testicles into their proper position. Laparoscopic orchiopexy is usually performed by experienced pediatric urologic laparoscopic surgeons.
Treatment options for testicles that cannot be felt
If the testicle cannot be felt by the doctor, it is called an "impalpable" testis. Impalpable testes may be inside the abdomen, too small to feel, or they may be absent.
Treatment options for impalpable testicles include:
Surgery to locate the testicle in the abdomen
There is no reliable imaging test that can show whether a testicle is in the abdomen. Surgery is usually required to locate the testicle.
The most accurate operation to locate these testicles is a laparoscopy procedure, which involves inserting a surgical instrument called a laparoscope into the abdomen through a small incision near the navel. The laparoscope allows your surgeon to examine the inside of the abdomen using a camera, and the results may show:
- No testicle, in which case the operation is over.
- A small testicle in the groin, in which case the testicle will be removed through an incision in the groin.
- A testicle inside the abdomen, sometimes called a high testicle, in which case an operation can be done to either remove the testis or move it into the scrotum. The operation to move high testicles into the scrotum is more difficult than the procedure to move testicles that are in the groin. Because of this difficulty, the success rates for this procedure are lower.
Undescended testicle treatment for adults
Options are different for adults with an undescended testicle. Bringing the testicle down to the scrotum will probably not affect fertility, and, therefore, an undescended testicle might be removed.
The ages of higher risk for testicular cancer are from 18 to 40, with most cases occurring in younger men. For this reason, doctors typically do nothing about undescended testicles after age 32.
Why Choose UPMC for Undescended Testicle Care?
When you choose UPMC for undescended testicle care, you will receive:
- Access to world-class urology expertise — Our world-renowned experts treat the full spectrum of male urologic and reproductive health conditions using the latest diagnostic and treatment techniques.
- A full range of treatment options — We offer nonsurgical and laparoscopic surgical treatments, depending on your condition and needs.
- Multidisciplinary care — Our team includes pediatric urologists, pediatric surgeons, pediatricians, and other specialists who provide comprehensive treatment.
