Undescended Testicle

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Topic Overview

What is an undescended testicle?

As a baby boy grows inside his mother, he develops testicles. Early in his development, his testicles are in his belly. Normally before he is born, his testicles move down into his scrotum, the sac that hangs below the penis. When one testicle does not move into the scrotum as it should, the baby has an undescended testicle . In rare cases, both testicles are undescended.

About 5 out of 100 baby boys are born with an undescended testicle.¹ It is most common in babies who were born before their due date or who were very small at birth. Why a baby’s testicle does not move into the scrotum is not well understood. It probably has a number of causes. This condition runs in some families (can be inherited).

In more than half of cases, the testicle descends on its own by the time the baby is 3 months old. If your baby’s testicle has not descended by the time he is 6 months of age, your doctor may suggest treatment.

What are the symptoms?

Having an undescended testicle does not cause pain or other symptoms. The scrotum may look a little smoother or less developed on one side, or the side without a testicle may look smaller and flatter.

How is an undescended testicle diagnosed?

At newborn and well-baby visits, your doctor will check your baby’s scrotum.

• If the testicle can be felt but it is not in the scrotum, the doctor will probably want to check your baby again at 3 to 6 months of age. By this time, the testicle may have moved into place on its own.
• Sometimes the doctor can't feel the testicle at all. It could still be in the baby's belly, it could be too small to feel, or it could be absent. After taking a wait-and-see approach, a doctor may recommend a type of surgery called laparoscopy to see if he or she can find the testicle. Laparoscopy requires only a small cut below the belly button, which heals quickly. During laparoscopy, the surgeon puts a tiny lighted instrument into the baby’s belly. The doctor may be able to move the testicle into the scrotum during this procedure so that the baby will most likely not need another surgery.
• If both testicles are undescended and cannot be felt in the groin, the doctor will do a blood hormone test to find out if the testicles are absent. It is rare to have two absent testicles.

Doctors sometimes use an imaging test, such as ultrasound, to help find an undescended testicle. These tests are more useful for older boys and men than for babies.

Some other conditions are closely related to undescended testicles. Your doctor will take care to make the correct diagnosis so your child can get the right treatment.

How is it treated?

Usually, doctors recommend a wait-and-see approach for newborns. If the testicle has not descended on its own within the baby's first year, your doctor may recommend surgery to move it into the scrotum, probably when the baby is 9 to 15 months old. In most cases, surgery takes about an hour. The baby will be given medicine so he sleeps through it. After surgery, the baby will be watched for a while after he wakes up, and then he can go home. Most babies recover quickly.

When babies have a testicle that can't be felt (nonpalpable), doctors may perform a different surgery that needs only a small cut (laparoscopy).

In some cases, the doctor may want to give your baby hormones before surgery to see if they cause the testicle to move down into the scrotum. Studies of hormone therapy have not found it to be very effective, and it can cause side effects. It may be a good option if the testicle is already very close to the scrotum.

Why is it important to treat an undescended testicle?

Treatment is important because having an undescended testicle increases the risk of:

• Infertility. Being in the scrotum keeps the testicles cool, which helps them make sperm. If the testicle remains inside the body, it stays too warm and its ability to make sperm drops. This can cause infertility later in life. Damage to the testicle's sperm-making ability can begin as early as 12 months of age. That is why many doctors advise treating an undescended testicle by the time a baby is 1 year old and no later than age 2.
• Cancer of the testicles. Although rare, testicular cancer is the most common form of cancer in men between the ages of 20 and 34.² And men who have undescended testicles have a much higher rate of testicular cancer than other men. This cancer can usually be cured, especially if it is found early. Treatment of an undescended testicle makes it easier for you or your doctor to find testicular cancer if it develops. If you are a young man who has an undescended testicle, talk to your doctor about what you should do. For more information about testicular exams, see the topic Testicular Examination and Testicular Self-Examination.

Last updated:	June 06, 2007
Author:	Debby Golonka, MPH
Reviewed By:	Michael J. Sexton, MD - Pediatrics, Peter Anderson, MD, FRCS(C) - Pediatric Urology
Editors:	Susan Van Houten, RN, BSN, MBA, Pat Truman, MATC