Approximately 3-4% of full-term baby boys are born with cryptorchidism, which is a condition where one or both testicles are not located in the expected scrotal position.
The prevalence rises to 30% in premature boys. This condition is easily detected and treated.
Anatomy of Undescended Testicles
The testicles of a male fetus develop within the abdomen. During the last couple of months of pregnancy, they drop through a passageway from the abdomen into the scrotal sac. Sometimes one testicle fails to descend into the scrotum. More rarely, both testicles may remain in the abdomen or otherwise fail to reach their final destination of the scrotum.
Causes of Undescended Testicles
- In premature babies, undescended testicles are usually simply a matter of the baby being born before it is time for the testicles to move into the scrotum.
- For full-term babies, the causes of this condition are not clear. It may have a genetic component if there is a family history of undescended testicles. It may be related to the parents’ exposure to pesticides or to the mother’s use of alcohol or cigarettes.
- In some cases, there is no testicle in the scrotum because it is never developed in the first place or it is damaged during the process of descent.
Risks of Undescended Testicles
This condition has risks if left untreated, and some of these risks persist even if the condition is treated. When the testicle is in the inguinal canal and not completely descended, it is at risk of testicular torsion. Torsion occurs when the cord that carries blood to the testicle becomes twisted, cutting off the blood supply. An undescended testicle may also have an associated inguinal hernia, which can allow a loop of intestine to slip into the groin.
Whether an undescended testicle is corrected or not, it carries an increased risk of developing testicular cancer. The risk is lower after treatment but still higher than if both testicles are descended at birth.
Fertility may be decreased in a man who is born with an undescended testicle. The earlier the condition is treated, the closer to normal his testicular development will be.
Treatment of Undescended Testicles
Treatment is not always required. More than half the cases of undescended testicles diagnosed at birth resolve as the testes descend by themselves within the first six months of life.
If the testicle has not descended on its own by about six months, surgery may be required. This may be either a laparoscopic procedure (if the testis is not palpable on physical exam) or an open surgery (if the testis is palpable). During surgery, the testicle is relocated into its normal position inside the scrotum and stitched into place. This procedure is called orchiopexy. The baby will require monitoring to be sure the testicle stays in place, but orchiopexy is very successful.
In the case where the missing testicle did not develop, prostheses are available to give the scrotum a normal appearance. This can alleviate any embarrassment or poor self-image for affected boys. Generally, prostheses are placed when the child is older to approximate a normal adult sized testis.