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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.
There are several reasons that UPMC pediatric urologists recommend treatment for persistently undescended testicles:
Treatment for the undescended testicle depends on the location of the testis.
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.
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:
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.
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.