Undescended testicle is one of the most common birth defects seen, occurring in as many as 5% of boys at birth. Undescended testicles are more common in boys born prematurely and may also run in families. In as many as 4 out of 5 boys born with this problem, the testis may move down into its normal place in the scrotum in the first year of life.
How are undescended testicles discovered?
Boys are examined after birth to check the position of the testicle. Since the testicle may come down on its own after birth, a boy with an undescended testicle is watched for at least 6 months. If the testicle does not come down, treatment is recommended. Sometimes, older boys will appear to have an undescended testicle when the testicles were thought to be normal before. This is not uncommon, because the testicle tends to retract upwards easily starting later in infancy and continuing through school age. This finding is because a muscle attached to the testicle may become very hyperactive in childhood. However, a “bouncy” testicle is not a problem and does not need treatment.
Will my son be able to have children?
After about 1 year of age, a testicle that is not down in the scrotum will start to lose some of its fertility potential. This is thought to be due to heat exposure from the testicle being so close to the body. If the testicle remains undescended, it may lose its ability to make sperm at all. Although most boys with 1 undescended testicle are able to have children, many of those who have the problem on both sides are not. We believe that moving the testicle down into the scrotum early in life reduces the risk of infertility.
What other problems can occur?
A hernia is more likely to develop on the side of an undescended testicle. Also, twisting of the testicle is more likely to occur, causing sudden pain on that side. There is a small chance of a tumor developing in an undescended testicle, even if it has already been brought down into the scrotum.
Why do undescended testicles need to be treated?
We recommend doing surgery to bring the testicle into the scrotum for the following reasons:
- to improve it’s chances of making sperm in adulthood
- to improve the outlook of the child, so that he feels more normal
- to reduce the risk of problems from twisting or hernia
- to bring the testicle into a position where it can be felt just in case a tumor develops in it
How are undescended testicles treated?
At present, surgery is thought to be the best treatment because it is safe and effective. Hormone treatments are used sometimes, but the treatment requires a series of shots and is less likely to work than surgery. At times, hormones are used to help decide if either testicle is present if neither one can be felt at the time of examination.
What type of surgery is used?
If the testicle can be felt in the groin, we recommend surgical correction (orchidopexy) through a groin incision. This incision is made in the lower abdomen, in the natural skin crease. The testicle is found, the blood vessels which feed it are lengthened and this allows us to put the testicle into the scrotum through a second incision. Very rarely, the blood vessels don’t reach and one of two sets of arteries must be cut to allow the testicle to reach the scrotum. If the testicle cannot be felt before surgery, we recommend looking for it with a telescope in the abdomen (laparoscopy) before making any incision. This helps us decide which incision to make.
What problems can occur after surgery?
Problems are uncommon after surgery. However, infection, bleeding, pulling up of the testicle into the groin or injury to the testicle or the ducts next to it can occur.
When to call the doctor. Call the doctor if your child has severe or worsening pain, high fever, the scrotum continues to swell or there is drainage or bleeding from one of the incisions. Mild swelling and bruising of the scrotum and a low grade fever is common after surgery. However, if you have any questions or concerns, please don’t hesitate to call.
What to expect as your child grows
Your doctor may want to check the testicle after healing is complete. Although the testicle can shrink after surgery, particularly if it was brought down a long way, it is not uncommon for the testicle to be smaller than the opposite, normal one in the first place. Rarely, the testicle pulls up again, and another surgery may be required. It is a good idea to teach your son to feel his testicles periodically after he goes through puberty to detect any sudden increase in size or shape.