Undescended Testicle

What is an Undescended Testicle?

Before birth, testes develop inside the tummy, beside the kidney. Towards the end of the pregnancy the testes travel through a passage in the tummy wall (called the inguinal canal) and on into the scrotum. Sometimes it can take a few months after birth for the testicle to make it all the way down to the scrotum. This is especially true in premature babies. The testicle should be in the scrotum by the age of 6 months.

If the testicle doesn’t make it all the way to the scrotum it is called an Undescended Testicle.

Most often only one side is affected, however in some rare cases both testicles may fail to make it to the scrotum.

Another name for an undescended testicle is cryptorchidism.

How are they diagnosed?

At birth all babies should have a baby check (sometimes referred to as a NIPE). During the baby check the scrotum should be examined to ensure that both testicles are present. If one or both testicles are not present in scrotum then this should be followed up by your family doctor to check if the testicle has come down after 3-6 months.

Sometimes parents spot that there is only one testicle when they are bathing their child or change their nappy. They notice that half of the scrotum looks empty and they cannot feel the testicle in the empty side of the scrotum.

If an undescended testicle is suspected, then the child needs to be examined by a doctor or an experience healthcare professional who will work out what is going on. They may find that the testicle is:

Retractile
Undescended
Impalpable - this means that the testicle cannot be felt. This needs to be treated differently to an undescended testicle. (Please see my information sheet on the Impalpable Testicle)

Some other young people are diagnosed when they are having their preschool check or they notice themselves when they are older. These young people may have a slightly different condition called an Ascending Testicle.

Empty left hemiscrotum - typical appearance of an undescended testicle

Typical appearance of the scrotum in a boy with an undescended testicle on the left side. The scrotum on the left looks empty

How common are they?

Up to 1 in 25 boys are born with undescended testes (the number is higher in premature babies).

By the age of 1 year only 1 in 100 boys have an undescended testicle.

What causes an undescended testicle?

In most cases the cause of the undescended testes is unknown.

There are a small number of congenital conditions that are known to be associated with having undescended testicles (such as prune belly syndrome, gastroschisis).

There are also a small number of hormonal conditions that can cause undescended testicles. In these cases both testicles will be affected. If this is found to be the case then the patient will need to be managed by both a Paediatric Urologist and a specialist Endocinologist (doctor who specialises in looking after problems with hormones.)

What is the treatment for an undescended testicle?

The treatment for an undescended testicle is an operation called an Orchidopexy. For more information on this operation please see my information leaflet on Orchidopexy.

For boys who have been born with an undescended testicle the operation should be carried out from 9 months of age. Often boys are not referred until this age, and so the surgery is often carried out later.

Why does a boy with an undescended testicle need treatment?

There are a number of reasons for treating an undescended testicle:

Fertility. There is evidence that the longer the testicle is left in an abnormal position the more microscopic damage is done to it. This will have an impact on the testicle in the long term, meaning that the testicle will not work as well. Doctors from both America and Europe (including the UK) recommend that the surgery is performed early for this reason.
Reducing the Risk of Cancer. There is evidence that the performing an orchidopexy in childhood reduces the risk of cancer of the testicle. As well as reducing the risk of cancer there is another benefit to bringing the testicle down to the scrotum. It is easy for men to do self examination on testicles that are located in the scrotum. It is much more difficult to do self examination on testicles that are in the groin. If a lump on the testicle is picked up early then it is usually easier to treat that growth. That is why self examination is important.
Cosmetic Appearance.

What is the long term outcome of Undescended Testicles?

Boys with a single undescended testicle that have it treated early have a good outcome, with a similar ability to father children as any other man in the general population.