What does this mean?
The day has finally arrived…your son was just born! He looks perfect and seems to be healthy, so it probably comes as a shock when the doctor is finished examining him and tells you that your son has an undescended testicle. What does this mean? Will your son be alright? What needs to be done to treat it?
Definition
An undescended testicle, also called cryptorchidism, is when a testicle is not in the scrotum. Testicles are normally formed in the abdomen and then gradually move into the scrotum through the inguinal canal during the last few months before birth. Occasionally, one or both of the testicles don’t descend into the scrotum like they are supposed to. The main symptom is that the testicle isn’t visible and/or can’t be felt inside the scrotum. Typically, the testicle will move into the proper position on its own within the first few months of life, but other times, it doesn’t. The cause of an undescended testicle is unknown, but thought to be related to genetics, maternal health and environmental factors that can impact hormones, physical changes and nerve activity that regulate the development of the testicles. Some things are thought to increase the risk of an infant possibly developing it, including low birth weight, premature birth, family history of it, conditions that limit fetus growth, alcohol use by the mother during pregnancy, smoking/secondhand smoke exposure during pregnancy and parents’ exposure to some pesticides.
Sometimes, boys who didn’t previously have an undescended testicle might be missing one later. There are a couple of possible causes. One is called a retractile testicle and is when the testicle goes back and forth between the scrotum and groin. Usually, it can be easily guided back into the scrotum by hand. This isn’t abnormal because it’s the result of a muscle reflex in the scrotum. The other cause is an ascending testicle and is when the testicle moves back into the abdomen and can’t be gently manipulated by hand back into the scrotum. This isn’t normal and should be examined by doctor.
The testicles need a slightly cooler environment in order to function correctly, this is why they are supposed to be in the scrotum. When they aren’t, it can lead to several different complications. It increases the risk of testicular cancer and fertility problems. It’s also more likely to cause testicular torsion, which is when the spermatic cord of the testicle gets twisted. Since inside this cord is the blood supply and nerves for the testicle, it can lead to them being cut off from the nutrients and oxygen they need, which can kill the tissue resulting in the need for the testicle to be removed if it’s not treated quickly. When a testicle hasn’t descended, it’s at a greater risk for trauma because it’s closer to the pubic bone, so any sort of injury to the area could cause it to hit the pubic bone resulting in damage.
Treatment
Since the complications of an undescended testicle are pretty significant, it’s important to make sure it gets corrected as soon as possible. In infants, since the testicle might descend on its own within the first few months, most doctors will recommend a wait and see approach. Typically, if the testicle hasn’t descended by the time your son is between 6 – 12 months old, he will need to have surgery to correct it. The surgery usually involves carefully inserting the testicle into the scrotum and stitching it into place. The procedure can be done via laparoscopy or open surgery. Unfortunately, the testicle might be poorly developed, abnormal or dead. If that is the case, it must be removed. After the surgery, the doctor will continue to monitor your son to makes sure that testicle is developing properly. This usually includes physical exams, hormone level checks and ultrasound of the scrotum. The good news is that the procedure has a success rate of almost 100% and fertility after the surgery for one undescended testicle is about the same as those born without any abnormalities. For those born with both testicles undescended, their fertility rate after the surgery is about 65%. Also, having the surgery done does decrease the risk of testicular cancer, but doesn’t eliminate it though.
Sometimes, if neither testicle is healthy and needs to be removed, or there are no testicles present, your doctor will recommend that once your son is in puberty to consider saline testicular prostheses for his scrotum. This will give it a normal appearance, which can make him feel less self-conscious. Also, if your son doesn’t have any testicles, the doctor will recommend that he see an endocrinologist in order to discuss hormone treatments for when he is older to replace what his body can’t produce. By doing this, it’ll help bring about puberty and physical maturity.
Prevention
Since the exact cause is unknown, it’s hard to pinpoint one thing that could prevent an undescended testicle from occurring. Currently, the best thing is to avoid any risk factors that you can during pregnancy. Also, as he gets close to puberty, it’s important to teach your son about doing regular, self-exams of his testicles. It’s key that he understands what is normal and what to look for that might indicate a problem.
If your son is missing one or both testicles, he might be self-conscious about his appearance. This is especially true if he is changing in a locker in front of others. There are some things that you can do to help him cope with this. The first is to teach your son to use the right words when talking about his testicles and scrotum. Next, it’s essential that he understands what the normal anatomy is and how he’s different, but that it doesn’t mean he’s ill or in danger of becoming ill. It can be helpful to role play responses to any teasing or questions he might receive from others. If your son wears loose fitting boxers or swim trunks, it might be less noticeable and he might be less embarrassed. Keep an eye out for any signs that he might be embarrassed, such as not participating in activities that he would’ve normally. Also, once your son is in puberty, it can be a good time to talk to him about testicular prosthesis and help him decide if this is a good choice for him.
As a parent, hearing that your son has an undescended testicle can sound like a huge, scary issue. The good news is that it usually resolves on its own and, if it doesn’t, the surgery to fix it is highly successfully. In either scenario, your son has a great chance of having no long-term complications. If you have any questions or concerns about undescended testicles, please talk to your doctor. If you would like more information, please visit the Urology Care Foundation’s Undescended Testicle page at https://www.urologyhealth.org/urologic-conditions/cryptorchidism