Undescended Testes (Cryptorchidism) | Diagnosis & Treatments
How are undescended testicles diagnosed?
A primary care doctor will first perform a full genital examination and will try to locate the testicle if it is not in the scrotum. If one can't be felt, your son may be referred to a pediatric urologist or pediatric surgeon for a more complete examination and to rule out two related conditions — etopic testicles and retractile testicles.
Ectopic testicles
If the scrotum is empty, the doctor may first try to determine if your child has ectopic testicles, a related condition in which the testicle is somehow diverted from its normal pathway of descent. As a result, the testicle lies in an abnormal location outside this pathway. To check for this, the physician will feel the areas where ectopic testicles are sometimes located.
Retractile testicles
Retractile testicles move in and out of the scrotum. Your doctor may try to rule out this condition by trying to bring the testicle downward. If the testicle can be brought all the way into the scrotum, no treatment is required. If your doctor determines that the testicle is not ectopic or retractile, the diagnosis is usually an undescended testicle. Your child will then be referred to a pediatric surgeon or urologist for further evaluation.
What are the treatment options for undescended testicles?
If your son's testicle does not descend on its own before his first birthday, his surgeon will most likely recommend a type of surgery called orchiopexy to move the testicle down into the scrotum.
If the testicle can be felt in the groin, orchiopexy will probably be done through a small incision in the groin. The surgeon will free the testicle from its location in the abdomen and maneuver it into the scrotum. Children often go home later that day or the next morning.
If the testicle cannot be felt in the groin (this occurs in one out of five boys with an undescended testicle), the testicle may be in the abdomen or may simply be absent. Further exploration is necessary to make sure a testicle is not left in the abdomen in order to permit the testicle to function properly and to reduce the risk of cancer developing undetected in that testicle.
Surgery is highly recommended in order to reduce the risk of cancer or infertility, to improve your son's body image through adolescence and adulthood, and to reduce long-term effects and the risk of cancer or infertility. In most cases, doctors are able to repair an undescended testicle with a single, simple operation at around 12 months of age.
What are the complications associated with surgery?
Complications from surgery are relatively rare, but in some cases can include bleeding and infection. The most common complication — which is still quite rare — is when the moved testicle goes back up into the groin. In this case, doctors will need to perform another surgery. In very rare cases, a testicle can lose its blood supply, which will render it nonviable. It will then become scar tissue. But again, this is very rare.
Your son may feel some discomfort after his operation, but most boys feel better after about a day. Your doctor will probably recommend that your son avoid sitting on riding toys for about two weeks in order to prevent injury to the testicle. You can expect annual follow-up examinations so the doctor can check that the testicle is growing normally.
What is the long-term outlook for children with undescended testicles?
Undescended testicles may increase the risk of infertility, especially if both testicles are affected. However, boys who have one undescended testicle tend to father children at the same rate as those who are not affected by the condition at all.
Boys who have two undescended testicles — a much lower percentage of patients — do have a significantly lower fertility rate. A child with undescended testicles is slightly more prone to develop testicular cancer, even after corrective surgery. However, surgery performed before puberty may reduce the risk of developing cancer.
Parents should know that cases of cancer related to undescended testicles are rare. Having the surgery is important in that the testicle is located where a young man can palpate a mass if it should develop.
Undescended Testes (Cryptorchidism) | Frequently Asked Questions
Do undescended testicles cause pain?
No, there is no pain associated with this condition.
Will my child need x-rays?
In most cases, a doctor will not be able to feel an undescended testicle by hand. However, imaging is not routinely necessary to evaluate for testicles that have not descended into the scrotum. In most cases, ultrasounds, computed tomography (CT) scans, and magnetic resonance imaging (MRI) have not been shown to be beneficial or helpful in the management of undescended testicles.
Will my child need surgery?
If your child’s testicle does not descend on its own, his surgeon will most likely recommend surgery to move it down into the scrotum around your baby's first birthday. The surgery, called orchiopexy, reduces long-term effects including risk of cancer or infertility, and will improve your son’s body image through adolescence and adulthood.
Can orchiopexy reduce my son’s chances of being infertile or developing undiagnosed testicular cancer?
Warmer temperatures inside the body can impair the development of the testes and may affect the production of healthy sperm. Orcheopexy moves the testicles into the scrotum, where they’re about three to five degrees cooler than they would be if they remained inside the abdominal cavity. This improves the chances of fertility later in life.
Orchiopexy also makes it possible for young men to easily and routinely examine their testes to detect any abnormalities such as testicular cancer.
Will my child’s genitals look ‘normal’?
The surgeons at Boston Children’s are experts in the surgical treatment of undescended testicles and are committed to making your son’s genital area look as normal as possible. Further genital repair is generally not necessary, though the area will be re-evaluated at different points in care and/or at different ages in your child’s development.
Will my son still go through puberty?
Yes, your son should still go through puberty.
If I have another son, will he also have undescended testicles?
There is no evidence that undescended testicles have a genetic component.
Will my son be able to play sports?
Definitely. The expectation is that your son should be able to enjoy a normal, active childhood just like his siblings, friends, and classmates.
Will my son be able to have children of his own?
Undescended testicles may increase the risk of infertility. However, boys who have one undescended testicle tend to father children at the same rate as those who are not affected by the condition at all. Boys who have two undescended testicles — a much lower percentage of patients — do have a significantly lower fertility rate.
What are the chances my son may develop testicular cancer when he gets older?
Boys born with undescended testicles are slightly more prone to testicular cancer, even after corrective surgery, and at a rate of less than 1 percent. However, recent studies suggest that surgical repositioning may help in early detection of a testicular mass prior to the spread of disease, which may reduce the rate of malignancies. It is important to note that testicular cancer is most often curable, given the available treatments. At Boston Children’s, we are at the forefront of research and committed to improving the long-term outlook for boys born with undescended testicles.