The testes first form in the abdomen during fetal development. As the fetus grows, the testes begin to move down, or descend, until they are inside the scrotum. Sometimes, one testis or both testes fail to descend, which is called undescended testis or undescended testicle.
Undescended testicle is a birth defect that occurs in as many as 3% of boys, making it one of the most common birth defects seen. It is more common in premature infants than those born at full term. Many cases of undescended testicles will self-correct, and the testis (or testes) will descend into the normal place within the scrotum within the first four months after birth.
How are undescended testicles discovered?
When boys are born, their first newborn examination includes checking the position of the testicles, so doctors will know right away whether the testicles have both descended or not. Because it is possible for the testicles to descend into proper position during the first few months of life, doctors normally won’t recommend treatment until your child is at least three months old. If the testicle does not descend on its own, doctors recommend treatment.
There are cases in which older boys appear to have an undescended testicle when the testicles had originally seemed normal. This can occur when a testicle is drawn up into the body due to a hyperactive muscle that is attached to the testicle. When the muscle contracts, it pulls the testicle up into the groin area, and when it relaxes, the testicle will descend again. This condition is relatively common in boys between the ages of 1 and 10, and it typically disappears after puberty. It does not require treatment. However, it is possible for a normally descended testicle to retract and become stuck in a position that is too high. This does require treatment.
Differentiating a true undescended testicle from one with the sliding condition is important, but it isn’t always a straightforward diagnosis. A pediatric urologist who specializes in conditions of the urinary tract system, which includes the testes, is often the best option for children who may have an undescended testicle.
Will my son be able to have children?
Testicles can lose some of their fertility potential when they are not in the scrotum for a long period of time. Experts believe this is because of the heat they encounter when in close proximity to the body. If a testicle remains undescended, it can eventually lose its ability to make sperm. Many boys with a single undescended testicle can father children, but most who have two undescended testicles usually cannot. At Beaumont, we believe that performing a procedure to help the testicle(s) descend into the scrotum early in life can improve fertility potential.
What other problems can occur?
Boys with undescended testicle are more likely to develop a hernia on the side of the undescended testicle. There is also a small chance that a tumor can develop after puberty in an undescended testicle, even if it has already been surgically descended. The risk for this type of tumor may be as high as 2%. Because of this higher incidence of tumors, it’s important that all boys who have had an undescended testicle get re-evaluated as teenagers and learn how to perform testicular self-exams on a regular basis.
Why do undescended testicles need to be treated?
We recommend surgery to correct undescended testicle to:
- improve the affected testicle’s chances of producing sperm
- improve your son’s self-confidence so he feels normal
- reduce the risk hernia or testicular twisting
- bring the testicle into a position where it can be felt and easily monitored for tumors in the future
How do you treat undescended testicles?
Currently, surgery is considered the best treatment because it is both safe and effective. Some doctors use hormone injections, but this option requires a series of injections, and it doesn’t usually work for truly undescended testicles.
What type of surgery do you use?
Inguinal Orchiopexy is a surgery that’s performed through a small incision in the groin. We make the incision in the natural skin crease of the lower abdomen to make it less noticeable. Once the incision is made, the surgeon will find the testicle and free the testicle and the affected blood vessels from the surrounding tissue.
Laparoscopic Orchiopexy is performed if we can’t feel your child’s testicle in the groin. This helps the surgeon find where the testicle is located and then bring it down into the scrotum.
What happens after surgery?
The surgery is usually quick – about an hour. After surgery, we recommend that you give your child medication (Tylenol with codeine) as needed. Make sure you follow the dosing instructions to avoid giving too much. The stitches will dissolve, so we won’t need to remove them, and the dressing we use to protect the incision will fall off on its own in about 1 to 2 weeks. Make sure your child doesn’t straddle anything or and doesn’t engage in any strenuous activity for 3 to 4 weeks after surgery. Make a follow-up visit with the surgeon approximately 2 weeks after surgery to make sure everything is healing well.
What problems can occur after surgery?
Most boys don’t have any problems after surgery. However, there is the potential for infection or bleeding. Although it’s uncommon, there’s a chance the testicle could pull up into the groin or the testicle or the ducts next to the testicle could be injured. Your son’s doctor will talk to you in more detail about risks and what you can do to reduce them.
What should I expect as my son grows?
Your son’s doctor may want to check the testicle after surgery once healing is complete. Sometimes the affected testicle will be smaller than the normal one. Although it’s possible for the testicle to shrink after surgery, especially if it had to be moved a long way, it is more common for an undescended testicle to be smaller in the first place.
Although it’s rare, corrected undescended testicles can sometimes pull back up into the body and may need to be surgically descended again.
Because boys with an undescended testicle are at higher risk for testicular tumors, even after surgical correction, it’s important for your son to feel his testicles regularly after puberty to detect any changes in shape or size. You should also have your son checked at puberty to make sure his undescended testicle is growing normally.