Testicles, undescended
Undescended testicles, medically known as cryptorchidism, is a condition characterized by testicles that do not reside in, or cannot be moved into, the scrotum. This condition affects approximately 3.4 percent of all male infants, with risk factors including being a firstborn or twin, low birth weight, and premature birth. While many cases resolve naturally within the first few months of life, about 1 percent of infants still experience undescended testicles at three months, and this percentage remains unchanged by one year of age. If left untreated, undescended testicles can lead to increased risks of infertility and testicular cancer later in life.
The recommended treatment involves surgical correction, known as orchidopexy, ideally performed by a child's first birthday to minimize health risks. Hormonal therapies, such as human chorionic gonadotropin (HCG), may also be utilized with varying degrees of success. Early intervention is important for proper reproductive health and to facilitate regular examination of the testicles. While cryptorchidism can occur on its own, it may also be associated with other genetic or endocrine disorders.
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Subject Terms
Testicles, undescended
ALSO KNOWN AS: Cryptorchidism
ANATOMY OR SYSTEM AFFECTED: Testicles, male reproductive system
DEFINITION: Testicles that neither reside in nor can be manipulated into the scrotum
CAUSES: Genetic and endocrine disorders
SYMPTOMS: Testicles that neither reside in nor can be manipulated into scrotum, increased occurrence of cancer, possible infertility
DURATION: Typically one to twelve months
TREATMENTS: Surgery, prosthesis for cosmetic purposes, hormonal therapy
Causes and Symptoms
The testicles, or testes, appear in males by seven weeks of gestation; by eight weeks, they are hormonally active. At eleven weeks, they produce testosterone, which is suppressed by maternal estrogens later in the pregnancy. These estrogens decrease before birth, causing a surge in production that is indispensable for the descent of the testes at about thirty-six weeks of and for future production.
About 3.4 percent of all male infants born after a will have undescended testes, or cryptorchidism. Risk factors include being first born or a twin, having a low birth weight, and/or being born prematurely, as well as being delivered by cesarean section. By three months of age, 1 percent of male infants still have undescended testes, a percentage unchanged by one year of age. In infants, most testes will descend by three months after the expected date at which the child should have been born (term).
The tissues of descended and undescended testes are the same for the first year. Thereafter, an undescended testis deteriorates and the chance of infertility increases. Rarely will testes descend spontaneously after six months of age.
Cryptorchidism may be isolated or be part of other conditions such as genetic or endocrine disorders, or intersexuality. Infertility affects about 50 percent of patients with unilateral (one-sided) cryptorchidism. Men with one or more undescended testicles are also at an elevated risk for testicular cancer later in life.
Treatment and Therapy
The American Academy of Pediatric Surgery recommends surgical correction of this condition (called orchiopexy) by the first birthday, thereby decreasing the incidence of infertility and tumors and making the testicle accessible for regular examination. If the testicle is absent, a may be inserted for cosmetic purposes. Hormonal treatment is also available, most often with human chorionic gonadotropin (HCG), with varying success rates. A surgeon or a pediatric urologist will evaluate the child and decide what is best for the individual patient.
Bibliography
Behrman, Richard E., Robert M. Kliegman, and Hal B. Jenson, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia: Saunders/Elsevier, 2011.
Montague, Drogo K. Disorders of Male Sexual Function. Chicago: Year Book Medical, 1988.
Rajfer, Jacob, ed. Urologic Endocrinology. Philadelphia: W. B. Saunders, 1986.
Rifkin, Matthew D., and Dennis L. Cochlin. Imaging of the Scrotum and Penis. Florence, Ky.: Taylor & Francis, 2002.
Smith, Nathalie. "Undescended Testes." Health Library, September 26, 2012.
Swanson, Janice M., and Katherine A. Forrest. Men’s Reproductive Health. New York: Springer, 1984.
"Undescended Testicle." MedlinePlus, medlineplus.gov/ency/article/000973.htm. Accessed 8 Apr. 2024.