Cryptorchidism is the medical term for an undescended testicle and is a rather common but treatable condition in male infants
Cryptorchidism is the medical term for an undescended testicle and is a rather common but treatable condition in male infants.
Cryptorchidism is estimated to occur in about 3 percent of male infants overall and 30 percent of male infants born prematurely.
Healthcare professionals can often treat cryptorchidism shortly after birth, ideally by six to 18 months. Most children fully recover, but cryptorchidism is associated with higher risks of fertility problems, hernia, testicular torsion, and testicular cancer.
The defining sign of an undescended testicle is a testicle that isn’t in its usual place in the scrotum. Usually, infants don’t experience any pain from this. Instead, it's typically noticed during a routine physical examination shortly after birth, or sometimes by parents during diaper changes or baths.
Other symptoms of undescended testicles might include:
Your child’s scrotum feels flatter on one side if only one testicle is affected, or on both sides if it's bilateral (meaning both testicles are undescended).
Sometimes, you might be able to feel the undescended testicle in the groin area, just outside the scrotum, but it can't be easily guided down into its proper place.
In other instances, the testicle may not be detectable by touch, suggesting it might still be higher up in the inguinal canal (a passageway in the abdominal wall) or even within the abdomen.
Having undescended testicles into adolescence and adulthood is uncommon in settings with routine pediatric care.
Cryptorchidism is caused by a problem with sexual development in the womb when the testicles and spermatic cord are initially forming inside the abdomen. Normally, the testicles start in the abdomen during development. As pregnancy progresses, the testicles gradually descend through a canal in the groin (the inguinal canal) and into the scrotum.
This process is typically completed by the time a baby reaches full term, but many factors can cause the testicles to remain in the abdomen.
While the exact reason a testicle fails to descend isn't always clear, it's generally understood to be a complex interplay of genetic, hormonal, and physical factors, such as:
Hormonal imbalances. The descent of the testicles is largely driven by male hormones (androgens). If there's an insufficient amount of these hormones or if the testicle isn't responding properly to them, the descent can be stalled.
Physical obstructions. Sometimes, a physical blockage or an anatomical abnormality in the inguinal canal can prevent the testicle from moving down. This could be due to abnormally short blood vessels or nerves, or even fibrous tissue.
Neural abnormalities. Improper function of the nerves involved in guiding the testicle's descent, like the genitofemoral nerve, might play a role, but more research is needed to understand this potential link.
Premature birth. Babies born prematurely have higher rates of undescended testicles because the descent often occurs in the later stages of pregnancy.
While the underlying cause of cryptorchidism isn’t always clear, certain factors can increase a baby's likelihood of being born with the condition. Knowing these can help in early identification, though they don't guarantee cryptorchidism.
Premature birth. Premature babies are at ahigher risk because the final stages of testicular descent often occur in the third trimester of pregnancy, although it can also occur in full-term infants.
Low birth weight. Infants with low birth weights are also more prone to developmental problems with their testicles, and premature babies are more likely to have low birth weights.
Family history. If a father or a brother had an undescended testicle, the chances are slightly higher for the baby. This suggests a potential genetic predisposition.
Maternal health issues during pregnancy. Conditions like gestational diabetes in the mother or the mother's exposure to certain environmental chemicals and medications may be associated risk factors, though more research is needed.
Other abnormalities. Babies born with certain differences, such as a problem with the abdominal wall, or with genetic conditions, such as Down syndrome, may also have higher rates of cryptorchidism.
It's important to reiterate that these are risk factors, not a guarantee that an undescended testicle will occur. Many babies born with undescended testicles have none of these risk factors, and many with risk factors do not develop the condition.
An undescended testicle is often discovered early in life, shortly after birth, by a healthcare professional, often when performing a general physical examination of the newborn. During an examination, they’ll also look for other potential differences of the penis, such as abnormal scrotal position.
If further tests are needed, your child may be referred to a pediatric urologist, a specialist in urology for children.
Further diagnostic steps might include:
Observation. For infants less than six months old, the doctor might recommend a period of watchful waiting, as the testicle may still spontaneously descend.
Hormone tests. In rare cases, especially if both testicles are undescended and can’t be felt, doctors might want to measure a baby’s hormone levels to check testicular function and look for or rule out sex development disorders.
In adults or older children, an undescended testicle might be noticed during a self-examination or during an exam by a pediatrician or family doctor. The doctor will gently palpate (feel) the scrotum and groin area to locate the testicles.
If a testicle isn't found in the scrotum but a doctor can feel it, they may attempt to gently guide it down from the groin. If it can be brought down into the scrotum easily and stays there without tension, it might be a retractile testicle. Retractile testicles usually don't require treatment and descend permanently with time.
Most of the time, testes that appear undescended at birth descend on their own within the first three to six months. However, after six months, this is unlikely. If an undescended testicle hasn't descended on its own by six months of age, surgery is typically recommended. The American Urological Association recommends surgery between the ages of six and 18 months.
The primary goal of treatment is to move the testicle into the scrotum and secure it there.
The gold standard treatment for an undescended testicle is a surgical procedure called orchiopexy. This procedure is effectively a guided descent, where a skilled surgeon helps the testicle find its correct spot.
For a testicle located in the groin, the surgeon makes a small incision in the groin area, gently frees the testicle from any surrounding tissue or attachments, and brings it down into the scrotum. They’ll then stitch it into place in a small pouch to prevent it from retracting.
For an intra-abdominal testicle (one still inside the abdomen), surgery can be more complex. Doctors often perform the procedure with small incisions and a camera.
Orchiopexy (also called orchidopexy) is typically an outpatient procedure, meaning your child usually goes home the same day. Recovery is generally straightforward, with pain managed by over-the-counter pain relievers. Most children are back to their normal activities within a few days to a week.
Many of the factors associated with undescended testicles aren’t under your control.
The main preventive steps to consider would be taken during pregnancy. Healthy prenatal habits support fetal development overall. Expecting mothers may be able to minimize the risk of issues at birth by:
Avoiding alcohol and smoking during pregnancy
Avoiding exposure to chemicals known to disrupt fetal development
Treating underlying conditions like obesity or diabetes
Avoiding pesticide exposure
Discovering your child has an undescended testicle can be worrying, but it's important to remember it's a common and highly treatable condition. Surgery is often successful and has a low risk of complications.
If you suspect a problem with your child’s testicle or development, it’s important to talk with their primary care provider. They’re your first and best resource to guide you through diagnosis and, if necessary, give you a referral to a pediatric urologist.
Children with an undescended testicle are at a higher risk of testicular cancer and some other conditions, such as testicular infertility and hernia. The risk of testicular cancer is higher when surgery is performed after puberty.
Along with testicular cancer, children with an undescended testicle may be at an increased risk of infertility, inguinal hernia, or testicular torsion.
No, an undescended testicle typically does not affect a child's puberty or hormone production (like testosterone). Even if one testicle is undescended and removed, the other healthy testicle can usually produce enough testosterone for normal puberty and male characteristics.
An undescended testicle is one that never fully reached the scrotum and cannot be easily manipulated down into its correct position. A retractile testicle, on the other hand, is a normal testicle that temporarily pulls up out of the scrotum. It can be easily guided back into the scrotum and will usually stay there.
While any surgery involves some discomfort, modern pain management techniques make orchiopexy very tolerable for children. They will typically receive general anesthesia during the procedure, so they feel nothing. Afterward, pain is usually mild to moderate, and the procedure generally has high success rates.
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