During the unborn male's development, the testicles are located in the belly. They slowly move down into the scrotum during the seventh month of pregnancy. When they drop, they pass through a small passage that runs along the belly near the groin called the inguinal canal. Once through the inguinal canal, the testicles reside in the scrotal sac. Since the scrotal sac is cooler than the body temperature, it is the ideal location for the testicles because they function better at this cooler temperature.

Undescended testicles (cryptorchidism) refer to a condition in which the testicle does not drop and cannot be brought into the scrotum with external manipulation. This occurs in 3 percent of newborn males and up to 21 percent in premature male newborns. Most testes drop by 3-4 months of age.

The undescended testis can be found in the belly, the inguinal canal or other places, but most are found in the inguinal canal (80 percent). About 10-15 percent of all cases involve both testicles.

This condition can run in the family. About 14 percent of boys with this condition come from families in which another male has it also. Six percent of fathers of males with undescended testis have also had this problem.

It is important to explain that "retractile testicles" are not undescended testicles. If a testicle can be brought down into the scrotal sac, even if it bounces back up again upon release, it is a retractile testis. These retractile testicles are in the scrotum at other times and do not need treatment.

Diagnosis of Undescended Testis

Parents or the child’s doctor can find a testicle that hasn’t dropped during a physical exam. Often, no testicle can be felt; this condition is called a non-palpable testicle (unable to be felt on examination of the scrotal sac). Often, the exam shows an inguinal hernia (an opening in the lower belly wall or inguinal canal where the intestines may stick out) as well.

Cause of Undescended Testis

It is not known why testicles don’t drop. It may be because the testicles were never normal before birth or that there was a mechanical problem that led the testicles in the wrong direction. Sometimes the infant's hormones may have not been enough to develop the testicles normally.

Symptoms of Undescended Testis

The testicle that has not dropped does not cause pain. The scrotal sac may look smoother, smaller or more flat than normal.

Complications of Undescended Testis

If an undescended testicle is not corrected, the following problems may occur as the male child grows up:

Infertility

If the testicles stay warmer than the rest of the body, there may be less sperm made.

Malignancy

An undescended testicle increases the risk of testicular cancer as an adult. If it is repaired, the undescended testicle does not decrease the risk of cancer but will allow for the testicle to be properly checked in the future and early finding of cancer if it forms. Even though the risk for cancer is increased, the risk is still thought to be low.

Trauma

A testicle that is trapped in a position that is not normal is more likely to be injured from trauma during everyday activity.

Testicular Torsion

Testicular torsion is a painful condition where the testicle can twist decreasing its blood supply and eventually leads to testicular loss. This can occur more often in a testicle that has not dropped.

Treatment of Undescended Testis

There are two treatment options: hormonal and surgical.

Hormonal

In cases in which both sides are undescended, hormonal treatment may aid the testicles’ descent into the scrotum. The hormone human chorionic gonadotropin (hCG) is given as an injection over several weeks. It cures undescended testes about 10 percent to 15 percent of the time. Surgery may still be needed.

Surgery

There are several possible procedures to correct this condition depending upon the location of the testicle and the distance to the scrotal sac.

1. An orchidopexy is an outpatient (patient does not need to stay in hospital) procedure which requires general anesthesia. This is performed when the surgeon can feel the testicle in the groin. A small incision is made in the groin; the testicle is located, freed from restrictive tissues, positioned and anchored in the scrotum. The passage way is then stitched closed to prevent re-ascent.

2. A laparoscopic orchidopexy procedure is frequently performed when you cannot feel the testicle on physical exam. The testicle may be in the abdomen, may be absent or very small.

Sometimes, the testicle is too malformed to be saved. It may have twisted sometime prior to the child's birth and lost its blood supply. During surgery, the remaining non-functional tissue is removed. The other testicle is secured in its scrotal sac to prevent testicular torsion of that testicle. If the malformed testicle is removed, a prosthesis (an artificial replacement) can be placed in the scrotum after puberty.

3. A testicular auto-transplant is indicated when the testicle is located very high in the abdomen and the blood vessels and other necessary structures are neither ample nor elastic enough to be stretched to the scrotum. The testicle must be "auto-transplanted" into the scrotum with all the necessary blood vessels and structures first cut and then reconnected.

Call Your Child's Doctor If:

• Unable to pee after eight hours following surgery
• Temperature of 101 degrees or above following surgery
• A green or yellowish discharge from the suture lines along with increased redness, swelling and pain
• Vomiting more than three times, unable to keep liquids down
• Extreme pain, not relieved by pain medicine

After Care

After Surgery Care for the Orchidopexy and the Laparoscopic Orchidopexy

• For pain control, you may give over-the-counter Tylenol every four hours, but do not exceed five doses in 24 hours. Children at least 4 years old may be given a prescription for a stronger pain medicine. Use this prescription only for significant discomfort and give as directed.
• We suggest you give your child pain medicine on schedule for the first 24 to 48 hours after surgery. After that, only give medicine if needed.
• Your surgeon will give you instructions on how to care for the surgery site.
• No tub baths for five days post-op; but your child may take a shower or sponge bath
• For four weeks, do not place your child in an exercise saucer or a walker, and avoid carrying them across your hip bone. It is fine to place your child in a car seat and highchair. For the older child, avoid riding a bike, climbing a jungle gym or participating in gym class.
• Your child may return to school or daycare when comfortable and does not need to take prescription pain medicine, usually in two to five days.

Your surgeon will provide after-surgery care for testicular auto-transplant.