Undescended Testicle

By Philip E. Gleason, MD

 

Undescended testicles represent an abnormality in which the testicle does not descend completely into the scrotum. Believe it or not, the testicle begins to develop around the kidney. During in utero development during pregnancy, the testicle then migrates down along the back and through the inguinal canal in the groin to be located in the scrotum at birth. Undescended testicles are, therefore, relatively common in premature boys. They occur in about 3% of boys at birth. There is some migration of some of the testicles after birth, during the first six to nine months of life. About 2/3 of boys that have an undescended testicle at birth will, in fact, have spontaneous migration or descent of the testicle into the scrotum during this period. However, approximately 1% of boys will ultimately end up with an undescended testicle that does not come down into the scrotum even during the first year of life. This would then be considered a true undescended testicle.

Undescended testicles are of some concern. Although we do not know exactly why, it seems that if the testicle is not located in the scrotum but is located in the groin or abdomen, it will be damaged. It appears that the temperature in the scrotum is somewhat cooler than the body temperature. If the testicle is located in the groin or abdomen, concern is raised that the testicle will be exposed to excessive body temperature and this does lead to testicular damage, called atrophy. This can impair and hinder future chances of fertility in adult years.

We therefore attempt to make sure the testicles have descended into the scrotum during normal examination at birth and through the normal well child physical exams. If, however, a testicle is considered undescended, further evaluation and treatment may be warranted. Occasionally the testicle actually appears to pull up out of the scrotum during normal growth and development and may, in fact, be discovered during the infant and even early childhood years even though it was descended into the scrotum at birth.

If a testicle is undescended, we would recommend further treatment including a small out patient procedure call orchiopexy. This involves coming to the hospital in the morning. The boy does have a general anesthetic. An incision is made in the groin and scrotum to free the testicle up from some surrounding tethering tissue which tends to hold the testicle back in the groin and prevent it from coming into the scrotum. The testicle is then freed up and brought down into the scrotum where a small pouch is created to hold the testicle in place permanently during future growth and development. This allows protection of the testicle from the body heat and allows future normal testicle function and prevention of infertility.

In the past, hormone treatments were sometimes used to try to stimulate the testicles to come down into the scrotum. Hormone therapy requires a series of numerous shots which are fairly painful and, unfortunately, is not very effective. In addition, sometimes even when the hormone treatment stimulates the testicle to come down initially, the testicle will pull back up into the groin during future growth and development. Hormone therapy is not used very much, if at all, anymore.

One last note, sometimes the testicle is normally descended into the scrotum. However, when the child is cold or excited, even as during a physical exam, the testicle will normally pull back up into the groin. This is called a retractile testicle. It does not appear to cause injury to the testicle as the testicle does, in fact, spend the great majority of its time in the scrotum in the normal position. Occasionally, it is difficult to differentiate whether a testicle is undescended or it is retractile. There is a growing consensus of opinion that in these difficult cases, we attempt to evaluate where the testicle spends the majority of its time. If it spends the great majority of its time in the inguinal canal, even if we can occasionally pull it into the scrotum on exam, we would be worried that the testicle would be exposed to body temperatures the majority of the time and be potentially at risk for developing future damage. There is a growing recommendation, therefore, to consider orchiopexy to bring those testicles into the scrotum to help protect them.

I hope this will provide a brief introduction to undescended testicles and their diagnosis and management.

 

© 2005-2010, Dr. Philip E. Gleason, MD