testicle, undescended

A boy born with an undescended testicle (cryptorchidism) may have

  • true undescended testes - a normal testicle descended on the right path but did not come all the way down
  • ectopic testes (ectopic = out of place) - the testicle came through the inguinal canal OK but wound up in the wrong place, usually under the skin of the groin
  • retractile testes are normal testicles with a hyperactive testicle elevating muscle (the cremaster muscle)
  • absent testes

The incidence of one or more undescended testicles is fairly high in full-term newborns (3.4%) and is much greater with increasing prematurity - 17% in infants with birthweights between 2,000 and 2,500 grams up to 100% in those boys born under 900 grams birthweight. This fact is because of the timing of testicular descent from the inguinal canal into the scrotum in the 7th month of gestation.

Concerns that arise over undescended testicles include

  • infertility
  • increased risk of tumor development in the undescended testes
  • associated inguinal hernias
  • possible torsion of the undescended testicle
  • possible psychological effects on the affected boy

Because spontaneous testicular descent does not occur after the age of 1 year, treatment of the single undescended testis is best undertaken early in the 2nd year of life. By the end of the second year, the number of germ (sperm forming) cells in the affected testicle is severely reduced, affecting future fertility. The operation is known as orchiopexy, and involves also repairing the inguinal hernia that is always present on that side. It is often day surgery, not requiring overnight stay.

If both testes are undescended (as occurs in up to 30% of cases of undescended testicle), the treatment approach is generally the same. However a hormonal stimulation test might be done if these testicles cannot be felt to determine if they are truly absent testicles.

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