Causes

Undescended testes are a congenital problem, meaning they are present at birth. The exact cause is not known, but this problem is believed to be partly inherited, as there is a slightly higher incidence of the condition among relatives of those who have it.

Risk Factors

The following factors increase your child’s chances of having undescended testes. If he has any of these risk factors, tell your doctor:

• Prematurity

• A family history of undescended testes

Symptoms

• Undescended testes cause no symptoms. They can, however, become twisted inside the abdomen (a condition called “testicular torsion”), a problem that requires surgery.

• Grown men with undescended testes may have low sperm counts resulting in infertility, and are at increased risk for hernia and testicular cancer because of their untreated undescended testes.

• In a similar condition called retractile testes (also known as “hypermobile” testes), descended testes slip easily back and forth between the scrotum and the abdomen. Retractile testes do not lead to cancer or other complications. They usually stop retracting by puberty and do not require surgery or other treatment.

Diagnosis

Your doctor will ask about your symptoms and medical history, and perform a physical examination. A diagnosis of undescended testes is usually made by a pediatrician based on the fact is one or both of the child’s testes cannot be felt within his scrotum. Additional tests may include the following:

• Abdominal ultrasound - A procedure that uses sound waves to make detailed computer pictures of the inside of the abdomen. This might be used to find out the exact location of the testes within the abdomen.

Treatment

Talk with your doctor about the best treatment plan for your child. Treatment options include:

• Giving the problem time to go away on its own. In most children, this happens by six months of age, without any other intervention.

• If the testes do not descend on their own, the problem can be repaired by a surgery called an orchiopexy. This is done while your child is asleep under anesthesia.

Prevention

There is no known way to prevent undescended testes. Preventible complications of undescended testes may occur, however, as your child grows and matures. These include:

• Infertility or testicular cancer in adulthood

• Injury to the undescended testes

• Emotional stress - While surgery usually results in a normal appearing scrotum, the undescended testis is sometimes smaller than the normal one. If your son becomes concerned about this as an older child or adolescent, a prosthesis (artificial replacement) can be placed in the scrotum.

RESOURCES:

American Association of Pediatrics
http://www.aap.org

National Infertility Association
http://www.resolve.org/

CANADIAN RESOURCES:

Caring for Kids, The Canadian Paediatric Society
http://www.caringforkids.cps.ca/

The Infertility Awareness Association of Canada
http://www.iaac.ca/

References:

Kolon TF, Patel RP, Huff DS. Cryptorchidism: diagnosis, treatment, and long-term prognosis. Urol Clin North Am. 2004;31:469-480, viii-ix.

Leung AK, Robson WL. Current status of cryptorchidism. Adv Pediatr. 2004;51:351-377.

Patil KK, Green JS, Duffy PG. Laparoscopy for impalpable testes. BJU Int. 2005;95:704-708.

Trussell JC, Lee PA. The relationship of cryptorchidism to fertility. Curr Urol Rep. 2004;5:142-148.