Cryptorchidism, commonly known as an undescended testicle, is a condition where one or both testicles have not moved into their proper position in the scrotum. This is a common congenital condition observed in newborn boys. While the presence of an undescended testicle can be a source of concern for parents, it is often a treatable condition.
Understanding Undescended Testicles
During normal fetal development, the testicles initially form in the abdomen near the kidneys. Around the third trimester of pregnancy, between the 25th and 35th weeks of gestation, they gradually descend through the inguinal canal, a passageway in the groin, and into the scrotum. This process is influenced by hormonal signals and physical guidance.
A true undescended testicle remains along its normal path of descent but has not reached the scrotum. Other types include retractile testicles, which can be manually guided into the scrotum, and ascending testicles, which move upwards after initially descending. An ectopic testicle descends to an abnormal location outside the usual path.
The prevalence of cryptorchidism affects approximately 3% of full-term male infants at birth, rising to about 30% in premature babies. Many cases resolve spontaneously within the first few months of life, with about 80% descending by the first year. Risk factors include prematurity, low birth weight, a family history of cryptorchidism, and certain maternal factors during pregnancy.
Recognizing the Condition
Cryptorchidism is identified through a physical examination performed by a pediatrician at birth or during routine well-child check-ups. The most apparent sign is the absence of one or both testicles within the scrotal sac. Parents might observe an empty scrotum, or if only one testicle is undescended, the scrotum may appear asymmetrical or unusually small and flat.
The condition presents without pain or other symptoms beyond the visible absence of the testicle. During diagnosis, a healthcare professional will palpate the groin and scrotal area to locate the testicle. This examination is performed in a warm, relaxed environment to prevent the testicle from temporarily retracting.
If the testicle is not palpable during the initial examination, a re-evaluation is recommended around 5 to 6 months of age to allow for potential spontaneous descent. Imaging tests, such as ultrasound, are not the first choice for locating an undescended testicle. Ultrasound has limited sensitivity for testicles that cannot be felt and often does not provide enough information to guide treatment. If a testicle remains non-palpable, further evaluation may be necessary to determine its exact location or confirm its absence.
Addressing Potential Concerns
Untreated cryptorchidism carries several health implications. Reduced fertility is a primary concern. Testicles function optimally at a temperature slightly lower than the body’s core temperature, provided by the scrotum. If a testicle remains in the warmer environment of the abdomen or inguinal canal, it can impair sperm production and maturation, leading to lower sperm count, reduced motility, and abnormal morphology. This risk is elevated when both testicles are undescended, with infertility rates exceeding 90% if left uncorrected.
There is also an increased risk of testicular cancer in undescended testicles. This risk is present even if the testicle is surgically corrected, though early intervention can help reduce it. The risk of developing testicular cancer is higher the longer the testicle remains undescended, with intra-abdominal testicles posing a greater risk than those in the inguinal canal. Testicular cancer is the most common cancer in males aged 15 to 35.
Testicular torsion is another potential complication, where the spermatic cord twists, cutting off the blood supply to the testicle. This medical emergency can lead to testicle damage or loss if not treated promptly. While rare, undescended testicles have a higher incidence of torsion compared to normally descended ones.
Undescended testicles are also associated with an inguinal hernia. This occurs when a portion of the intestine bulges through a weak spot in the abdominal wall into the groin area, often presenting as a swelling. If the condition is not corrected, it can lead to psychological impacts, such as embarrassment, anxiety, and low self-esteem related to body image in adolescence and adulthood.
Treatment Options and Outcomes
The primary treatment for an undescended testicle is a surgical procedure known as orchiopexy. This operation involves bringing the testicle down into the scrotum and securing it in place. The surgeon makes a small incision in the groin area to locate the testicle, often found in the inguinal canal. A separate small incision is then made in the scrotum, allowing the testicle to be gently pulled down and stitched into a created pouch. If the testicle is not palpable, diagnostic laparoscopy can be used to locate it, and the procedure may be performed in one or two stages.
Orchiopexy is recommended between 6 and 18 months of age. Early intervention is preferred to mitigate risks such as impaired fertility and testicular cancer. While hormone therapy has been explored, its role in inducing testicular descent is limited and not recommended as a primary treatment due to low success rates and side effects. Hormone therapy can be considered in specific cases, such as bilateral cryptorchidism related to certain hormonal deficiencies, but surgery remains the standard treatment.
Following orchiopexy, patients can expect some pain or discomfort for a few days to a week, managed with prescribed pain medication. Swelling and bruising in the scrotum are normal and subside within a few weeks. Most children can resume normal activities within two to three days, but strenuous activities, contact sports, and straddle toys should be avoided for several weeks to ensure proper healing and prevent the testicle from re-ascending.
The long-term outlook after orchiopexy is favorable, with high success rates for the testicle to remain in the scrotum. Early surgical correction can reduce the risks of infertility and testicular cancer. While some men with a history of unilateral cryptorchidism have fertility comparable to the general population, those with bilateral undescended testicles, even after correction, experience reduced fertility. Continued follow-up with a healthcare provider is important for monitoring testicular health and development. Boys who have undergone orchiopexy should be educated about performing regular testicular self-examinations once they reach puberty to aid in early detection of any changes.