Undescended Testicle

An undescended testicle (cryptorchidism) is a testicle that hasn't moved into its proper position in the bag of skin hanging below the penis (scrotum) before birth. 

Usually, just one testicle is affected, but about 10 percent of the time both testicles are undescended.

An undescended testicle is uncommon in general, but common among baby boys born prematurely.

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What is Undescended Testicle?

A lot of crucial changes occur within the womb in the last few months of pregnancy. The eyes open, there is rapid weight gain, and the bone formation is completed. 

It is also when the testicles in the boys descend from the lower belly into the scrotum which is a bag of skin situated below the penis.

But sometimes, one or both of the testicles fail to fall in the proper place which is referred to as an undescended testicle. It is common in babies that are born prematurely.

The testicles should ideally descend into the scrotum by the time the baby turns six months but if this does not happen the child will have to undergo surgery.

An undescended testicle is also known as cryptorchidism. 

During the early phase of pregnancy, the testicles that are being formed within the womb are under the control of many hormones, and by 32-36 weeks, the testicles begin to move down into the scrotum. 

In the majority of males born prematurely or some born as full-term infants, one or both of the testicles fail to descend at the right time which is ideally at birth. 

Out of these, most of them descend in the following three to six months of age. By six months, this problem persists in less than 1% of babies.

What are the symptoms of Undescended Testicle?

The scrotum appears smaller on the affected side.

In rare cases, the undescended testicle can become twisted leading to testicular torsion that causes extreme pain in the groin. This requires immediate medical attention.

What causes Undescended Testicle?

The causes are debatable. Some say it is attributed to genes, the mother's health, and outside factors, some blame the hormones and nerves at play.

Certain factors that contribute to developing this condition include:

  • Prematurely born or low birth weight infants are likely to develop it.

  • Family history of developmental problems

  • Medical syndromes that are associated with this condition like Down syndrome affecting the growth of the fetus within the womb

  • Contact of the mother with certain chemicals / industrial pesticides during pregnancy

  • If the mother has diabetes (type 1, type 2, or gestational), is overweight, has drunk alcohol, or smoked cigarettes during pregnancy.

What are the other conditions that can lead Undescended testicles ?

Fertility problems: 

The sperm produced needs a cool environment as compared to the rest of the body and if the testicles fail to descend, the sperm produced is likely to be lodged in the groin area especially if both the testicles are undescended.

  • Hernia formations: bulging of intestinal tissues through the muscles of the lower abdomen.

  • Injury: the testicles that are in unusual positions are likely to get injured.

  • Cancer: Children with an undescended testicle are a little more likely to get testicular cancer.

  • Testicular torsion: The cords carrying semen to the penis get entangled with each other leading to obstruction of blood flow to the testicles.

How is Undescended Testicle treated?

The undescended testicle is at a higher temperature than it should be in the normal case. The testicles need to be at a lower temperature to make good quality sperm. 

The higher temperature can affect this and in the future can lead to long-term infertility.

The treatment options include:

• Hormone treatment using an injection of human chorionic gonadotropin (HCG) which enables the testicle to move down into the scrotum. But its effectiveness is less as compared to surgery.

• Open surgery: The surgeon makes large incisions over the groin or abdomen

• Laparoscopy: A scope with a camera attached to it is inserted through a small incision over the abdomen.

The most common surgery to treat it is an Orchiopexy in which a cut is made in the groin area to bring the testicle down into the scrotum which is then fixed in that position.

This surgery can be performed as an open surgery or through Laparoscopy. Most boys recover fully within a week.

Boys with this condition must undergo surgery between 6 to 12months of age.

Early surgical intervention helps to reduce the risk of potential complications.

Regular check-ups throughout life may be needed to monitor the condition and look out for any other alarming signs. 

This can be done through physical examinations, hormonal tests, an ultrasound of the scrotum as and when advised by the doctor.

If during Laparoscopy the doctor finds that there is no testicle present, or a very tiny bit of non-functioning testicular tissue is remaining, the surgeon removes it. 

In this case, you can consider saline testicular prosthesis for the scrotum. These prostheses help to give the scrotum a normal appearance and this can be inserted during late childhood or adolescence.

Initially, the doctor may recommend a wait and watch period of up to six months during which ideally the testicles should drop into the scrotum otherwise the doctor will recommend surgery.

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