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UNDESCENDED TESTES - CRYPTORCHIDISM

What are Undescended Testes ?

During development of the male embryo in the womb the testicles grow and develop inside the abdomen. They move down into the scrotum towards the end of pregnancy. In some babies this does not happen properly and one or both testicles are not in the scrotum. Many of these will descend after the child is born. As the child gets older this becomes more unlikely and some treatment to bring them down is needed. Some boys have testicles which have come down into the scrotum but can move up and down easily. Often they are pulled back up into the abdomen when the child is cold. These are not truly undescended testes and are called retractile testes. They do not need any treatment.

How do Undescended Testes occur ?

For most boys there is no reason for undescended testes. Sometimes the canal they descend through is blocked. Very rarely a problem with the testis or a hormone problem will cause undescended testes.

Why do Undescended Testes occur ?

It is not known why only some children are affected.

Treatment Involved for Undescended Testes

It is important to tell if the testicle is truly undescended. If you can feel both testicles when the child is warm and happy, such as in a warm bath, they are not undescended. If the testicle is undescended, the baby should see a doctor who will decide if an operation is needed. An ultrasound scan may help in telling where the testicle is. In a few cases hormone injections can help the testicle to come down. If the doctor thinks that the testicle is not likely to come down on its own an operation is needed. This is done through a cut above the groin under a general anaesthetic. During the operation the surgeon will find the testicle, bring it down to the right place and put a stitch to keep it there. This operation will be more difficult if the testicle is inside the abdomen than if it is partly descended and already nearly in the right place.

During Treatment for Undescended Testes

This is a sensitive part of the body and there will be some discomfort after the operation. He may need painkillers. He may need to stay in hospital, and will take a short while to get back to normal activity.

After Treatment for Undescended Testes

The surgeon will see the child as an outpatient to check that everything has settled down. It is very rare for the testicle to slip back up after an operation. For most boys there will be no more problems and the testicle will work normally. Very rarely there is a hormone problem or the testicle itself is not normal. These boys may need further tests or treatment. If a testicle is not normal it may not be able to produce male hormone (testosterone) or sperm. Problems are more likely to arise if both testicles are undescended, because only one testicle is required for fertility and for normal sexual development.

If Undescended Testes are left untreated

Testicles only work properly if they are slightly cooler than the rest of the body. In the scrotum they are at the right temperature. Undescended testicles are too warm and will not be able to produce sperm properly : even male hormone production can be affected. This would result in problems developing in puberty and possibly infertility. Undescended testicles are more likely to become malignant (cancerous). If they are inside the abdomen the lump caused by any cancer would not be seen. This is important because the treatment for cancer of the testicle, once diagnosed is very effective.

Effects on family of Undescended Testes

Even a very young boy is sensitive about his private parts. He can be distressed when people examine him. Tell him about what will happen before you go to hospital and try to be calm and relaxed yourself. Staff at the hospital can help you prepare him for an operation.