Undescended Testis

A testicle discovered in the scrotum is considered descended. Undescended testicles are common in premature infants, but also present in three to four percent of full-term infants. Generally, testicles descend within nine months. Testicles that have not descended by one year should be evaluated for treatment, including definitive surgery, to avoid permanent testicular damage or the risk of cancer, which increases with the condition.

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Symptoms

Causes and Risk Factors for Undescended Testis

While the causes of undescended testicle are unknown, risk factors include:

  • Family history (father or brother with undescended testis)
  • Birth before 37 weeks
  • Twin or triplet birth
  • Mother exposed to estrogen during first trimester
  • Birth weight less than 2500 g

If no testicle is found, the cause may be:

  • Abnormality of the genitourinary system (possible hypospadias)
  • In utero vascular insult - a result of testicular torsion (twist)
  • Congenital anomaly
  • Congenital absence (a testicle never existed)
  • Testicle atrophy before birth
  • Incomplete or improper descent (remaining in the abdominal cavity)
  • Retractile testicles - testicles found in the groin but can be brought into the scrotum during examination.

Symptoms of Undescended Testis

An undescended testicle generally presents no symptoms except its inability to be located within the scrotum. In adult males, infertility may also serve as a symptom.

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Diagnosis

A physical examination at birth to locate the testis is the most common method of diagnosis. Prenatal ultrasound also may be used. An unbalanced scrotum is an indication of an undescended testicle.

In a physical examination, an undescended testicle may be capable of being felt (palpable). If the testis is not palpable, it may be in the abdomen. It also may be absent, which occurs in approximately five percent of cases as a result of an abnormality in testicular blood vessels or testicular torsion (twist).

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Treatments

Most cases of undescended testis resolve without any treatment. Treatments, which are generally not recommended until after one year of age, may include manipulation into the scrotum (retractile cases), hormone therapy and in rare cases, surgery.

Successful treatment of undescended testis can:

  • Prevent testicular torsion (twist)
  • Promote early detection of testicular cancer
  • Improve fertility
  • Reduce risk for injury
  • Help solve body image issues

Surgery

If the testicle is located outside the abdomen, an orchidopexy or orchiopexy is performed under general anesthesia. The testicle is removed through a small incision, then placed into the scrotum through another small incision, and may be sutured into place. Success rates are good and fertility is generally achieved.

An undescended testis also can be treated laparascopically. A small incision is made near the navel and a telescope-like instrument with a small camera and light (laparoscope) is inserted into the abdomen to view the area and locate the testicle. If the testicle is malformed, the testicle is removed or an orchidopexy is performed.