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Undescended testes (cryptorchidism)

 
When a baby boy is developing inside his mother’s womb his testicles normally move from their original position in the abdomen into the scrotum during the eighth month of pregnancy.

Undescended testes (known medically as cryptorchidism) occur when one or both testicles do not reach the scrotum and remain inside the boy’s abdomen or groin (inguinal canal). In New Zealand, the condition may occur in up to 4% of new-born boys and occurs more commonly in premature babies.
 
The exact cause of the condition is unknown. However, in addition to premature birth, low birth weight and a family history of undescended testicles might increase the risk of an undescended testicle occurring in the new-born.

In most cases, a testicle that is undescended at birth will naturally correct itself by the age of three or four months. If a testicle is still undescended after four months of age it is unlikely that it will descend naturally and surgery to move the testicle to its correct position in the scrotum may be required.

Undescended testes are not painful and do not pose an immediate risk to health. However, testes need to be in an environment that is a few degrees cooler than the rest of the body. If a testicle does not descend into the scrotum, the warmer environment inside the abdomen or groin can cause it to develop abnormally. The testicle may fail to grow (atrophy), sperm production may be affected (possibly contributing to a reduction in fertility), and there is an increased risk of testicular cancer in later life.

Diagnosis

An undescended testicle is usually detected at birth after a physical examination. It may be recommended that the condition is regularly monitored to see if the testicle does descend. This may be done by a Plunket nurse or GP.

If the testicle has not descended by approximately three months of age, a referral to a specialist may be made. The doctor will carefully examine the scrotum, groin and abdomen to locate the testicle. If the testicle is unable to be moved into the scrotum, or it retracts immediately, a diagnosis of an undescended testicle is likely to be made. 

If an undescended testicle cannot be felt inside the abdomen by physical examination, surgery may be required for a diagnosis.

Treatment

Surgery for undescended testes and is usually performed within the first year after birth. The testicle is returned to its normal position in the scrotum during an operation called an orchidopexy. This operation is performed under a general anaesthetic, usually as a day-stay procedure. An overnight stay in hospital may be required in some cases.

The surgery may be performed laparoscopically, which requires a small incision (“keyhole surgery”), or may require a larger incision in the groin and scrotum ("open surgery"). With both surgical techniques, the testicle is located, moved to the required position in the scrotum, and stitched into place so that it does not retract. The incisions are closed with small dissolvable stitches. 
 
Orchidopexy is a relatively simple surgical procedure and has a high success rate. Performed at an early age, orchidopexy reduces the risk of fertility problems and testicular cancer later in life.

Recovery

After the operation, the child will be given medication (such as paracetamol) for pain relief. The child will recover in the ward and most children are able to go home once they are eating and drinking. The doctor will recommend recovery and activity guidelines for the child and will advise how to care for the child’s wounds. Many children will be playing and active the day after the operation. 

References

Mayo Clinic (2019). Undescended testicle (Web Page). Rochester, MN: Mayo Foundation for Medical Education and Research. https://www.mayoclinic.org/diseases-conditions/undescended-testicle/symptoms-causes/syc-20351995 [Accessed: 21/11/20]
NHS (2018). Undescended testicles (Web Page). Redditch: National Health Service (NHS)England. https://www.nhs.uk/conditions/undescended-testicles/ [Accessed: 21/11/20]
O’Toole, M.T. (Ed.) (2017). Cryptorchidism. Mosby’s Dictionary of Medicine, Nursing & Health Professions (10th ed.). St Louis, MI: Elsevier.


Last Reviewed: November 2020
 
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