Undescended Testicle

Overview
Treatment

Undescended Testicle Overview

An undescended testicle, sometimes called a cryptorchidism testicle, is a common problem in young boys.

Who Does Undescended Testicle Affect?
Up to 30 percent of premature boys, up to five percent of boys born at term, and up to one percent of one-year-old boys will have at least one undescended testis.

As the numbers imply, most of these early undescended testicles will come down to the scrotum over the first year of life. Actually, most of them come down by three or four months, but very few descend after that.

How Do Undescended Testicles Form?
The testicle originally forms in the back of the abdominal cavity, similar to the position of the ovaries in girls.

Near the end of pregnancy, the testis begins to descend to the scrotum. A path is cleared for the testis by a structure called the processus vaginalis— essentially a groin or inguinal hernia. The testicle follows the back wall of the hernia into the scrotum, and then the hernia closes.

If the process is incomplete, the testicle 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 "ectopic" location, usually not far from the scrotum.

Why treat an undescended testicle?

There are several reasons that UPMC pediatric urologists recommend treatment for persistently undescended testicles:

Undescended Testicle and Infertility
Testicles are in the scrotum because this is a cooler location than other places in the body. This minor temperature difference may have a dramatic influence on the ability of the testicles to make sperm, needed for fertility. It has been demonstrated that the testicles begin to lose the cells that make sperm very early in life if they are not in the scrotum. This process has probably begun by one year of age. Bringing the testicle into the scrotum early might preserve these cells and, therefore, improve chances for fertility in the future.
Undescended Testicle and Higher Risk of Testicular Cancer
Testicles that are undescended have a higher risk of developing testicular cancer than those that descend spontaneously. The overall risk of cancer is probably only one in 2,500, but this is still higher than the general population. Bringing the testis into t he scrotum allows more accurate examination—both by doctors and by the young men themselves—and, therefore, will result in earlier detection of these tumors if they should occur.
Undescended Testicle and Hernia
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 (or inguinal hernia).

Undescended Testicle Surgery and Hormone Treatment

Treatment for the undescended testicle depends on the location of the testis.

Options for testicles felt in the groin area

Surgery to Treat Undescended Testicle
For testes that can be felt in the groin area, the usual recommendation is an operation called anorchiopexy or orchidopexy. This literally means "fixing the testis."

This surgery is almost always performed as an outpatient procedure. It is done through a small hernia incision in the groin and takes up to an hour and a half to perform. Recovery is generally very rapid and the outcome is usually good.

Hormone Treatment for Undescended Testicle
An alternative is hormonal treatment with HCG, a series of injections that stimulate the testicles to make hormones.

In a small number of boys, this treatment will result in permanent descent of the testicle. Hormonal treatment is sometimes recommended if the testis is very close to the scrotum and there is a good likelihood of success.

Options for testicles that cannot be felt

If the testicle cannot be felt by the doctor, it is called an "impalpable" testis (which simply means "cannot be felt"). Impalpable testes may be inside the abdomen, too small to feel, or they may be absent.

Surgery to Locate Testicles in the Abdomen
Unfortunately, there is no reliable x-ray that can tell us whether a testis is in the abdomen. Generally, surgery is required to make that determination.

The most accurate operation to locate these testicles is a laparoscopy, a procedure in which a telescope is placed into the abdomen through a small incision near the navel. The abdomen can be examined with a telescope, and the results may show:

No testicle, in which case the operation is over.
A small testicle in the groin, in which case a groin incision is made and the area is explored for a small testis, which must be removed.
A testicle inside the abdomen, 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 for the testicles that are in the groin. Because of this, the success rates are lower for these high testicles.

UPMC pediatric urologists and others have been developing and refining the technique of laparoscopic orchidopexy, which has proven to be a safe and effective method for bringing these testicles down. Laparoscopic orchidopexy is an operation that can be done by experienced pediatric laparoscopic surgeons.

Options 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 simply be removed.

The ages of higher risk for testicular cancer are from 18 to 40, with most occurring in younger men. For this reason, and due to the increased risk of anesthesia in older patients, it has been recommended that nothing be done about these testicles after age 32. This is an individual consideration and you should consult with your physician.

Treatment at UPMC

UPMC Urologists
To schedule an appointment, call 412-692-4100 between 9 a.m. and 5 p.m., Monday through Friday.

Department of Pediatric Urology at UPMC Children's Hospital of Pittsburgh
Call 412-692-5400 between 9 a.m. and 5 p.m., Monday through Friday, to schedule an appointment.