A newborn and mother

An undescended testicle happens when a testicle fails to move into the normal place in the scrotum. Located behind the penis, the scrotum is the sack of skin that holds the testicles. The testicles typically descend into the scrotum before a baby is born.

Having one or two undescended testicles (also called cryptorchidism) is common in premature infants. According to the Urology Care Foundation, it affects about 20% of premature boys. Doctors see it in about 3% of full-term newborns.

Doctors rarely see undescended testicles in adult men who were never treated for the condition as children.

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What Causes Undescended Testicles?

When a baby is in his mother’s womb, testicles form in his abdominal cavity. Sometime in late pregnancy, the testicles begin to move through the body into the scrotum. But sometimes the testicle stays inside the abdomen or doesn’t make it all the way into the scrotum.

Doctors don’t know exactly what causes undescended testicles. It may be a combination of genetics, the mother’s health, and environmental factors.

Risk factors for undescended testicles include:

  • Premature birth.
  • Low birth weight.
  • Conditions that slow fetal growth, such as Down’s syndrome.
  • Family history of problems with genital development.
  • Smoking during pregnancy.
  • Pesticide exposure during pregnancy.
  • Maternal diabetes.
  • Maternal obesity.

What Are the Symptoms of Undescended Testicles?

If one or both of your child’s testicles haven’t descended, the scrotum looks flat and small. Your pediatrician will examine your baby’s testicles at birth and at every checkup.

Before puberty, some boys have a condition called retractile testicles. A muscle reflex pulls the testicles out of the scrotum and into the groin when the child is cold or frightened. They return to the scrotum when the child relaxes or warms up. As the child ages, retractile testicles can become ascending testicles over time. This is why having an annual examination which includes a testicle exam is very important.

A doctor is able to tell the difference between undescended and retractile testicles on examination. Ultrasound tests can be misleading or incorrect, so they are not typically performed to check the location of testicles.

Can an Undescended Testicle Lead to Other Problems?

A man with an undescended testicle is at greater risk for:

  • Testicular cancer. This is the most common cancer in men between the ages of 15 and 35. About 9,600 cases occur in the United States each year. More than 400 men die from it annually.
  • Infertility. The testicles need to be at a lower temperature than the rest of the body to produce sperm. If they remain inside the abdomen, the temperature is too warm. If they remain inside the abdomen for too long, this can permanently damage the ability of the testicles to make sperm.
  • Hernias. When a boy is still in utero, a hernia forms in the abdomen as a path for the testicle to follow. If the testicle doesn’t descend, the hernia doesn’t close and will cause problems as the child grows.
  • Testicular torsion. When the testicle is in the wrong place, the cord between the testicle and the penis can become painfully twisted. A damaged cord can lead to loss of the testicle.

What Is the Treatment for Undescended Testicles?

The treatment for undescended testicles depends on several factors.

Treatment for boys

In about half the cases, the testicle descends in the first few months of life and no treatment is necessary.

After a baby is six months old, doctors will consider surgery to fix the problem. Pediatric urology surgeons perform this procedure with traditional surgical techniques or by laparoscopy.

This is an outpatient surgery. The child has general anesthesia and can usually go home the same day. He should be feeling normal within a few days. There is often bruising in the scrotum which lasts for a few days after surgery.

Treatment for adults

For adult men with undescended testicles, the advice is different. Moving the testicle into the scrotum in adulthood is unlikely to improve fertility. A surgeon may opt to remove the testicle instead.

If no hernia or pain is present in the undescended testicle, doctors may recommend leaving an undescended testicle alone in men over 40 years of age. Testicular cancer is most common in young men, so an undescended testicle is not a major health risk for older men.

Sources

Urology Care Foundation, A Patient's Guide to Undescended Testicles. Link.

Urology Care Foundation, What are Undescended Testicles (Cryptorchidism)? Link.

American Cancer Society, Key Statistics for Testicular Cancer. Link.

U.S. National Library of Medicine, Undescended Testicle. Link.

National Institutes of Health, Cryptorchidism. Link.

Medical News Today, What is cryptorchidism, or an undescended testicle? Link.

Harvard Health Publishing, Undescended Testicle (Cryptorchidism). Link.

About Urology

The UPMC Department of Urology offers a wide variety of specialized care for diseases of the male and female urinary tract and the male reproductive organs. We have a multifaceted team of physicians and researchers working together to provide the best care to both children and adults. Our team is nationally renowned for expertise in highly specialized technologies and minimally invasive surgical techniques. U.S. News & World Report ranks UPMC Presbyterian Shadyside among the best hospitals in the country for urological care.