What is an undescended testicle?
In the last months of pregnancy, the baby undergoes all sorts of
changes. Eyes expand, bones are fully formed, and weight gain accelerates. In
boys, this also happens when the testicles move from the lower abdomen to the scrotum,
that pocket of skin under the penis.
But sometimes one or both testicles do not fit into place. This is
called an undescended testicle. It can happen to any boy, but is more common in
those born earlier than expected.
Most often, by 6 months, the testicle descends into the scrotum on its
own. Otherwise, the child will most likely need surgery.
What are the reasons?
Doctors don't know why this happens. They believe it has to do with
genes, maternal health, and environmental influences that alter the normal
functioning of hormones and nerves.
Although the cause is unclear, several factors may make an undescended
testicle more likely:
- An earlier-than-expected birth
- Family history of them or other problems with how genitals develop
- Health conditions, such as Down syndrome, that affect how a fetus grows
- Low birth weight
- Contact by the parents with certain chemicals that kill bugs
It may also be more likely if the mother:
- Has diabetes
- Is obese
- Smoked cigarettes or drank alcohol during pregnancy
How do I know there is a problem?
Main symptom: You cannot see or feel the testicle in the scrotum. When
both have not drooped, the scrotum appears flat and smaller than expected.
Some boys have what is called a retractile testis. It may rise to the
groin when they are cold or frightened, but descend on its own. Usually this is
not a problem. The difference is that an undescended testicle remains upright.
Diagnosis
In most cases, the doctor identifies the problem during a regular
check-up shortly after birth.
If your doctor thinks there is a problem, they may try to rule out other
causes, such as:
- Ectopic testis. This is a similar
condition where the testicles do not fall into place. Your doctor may check
this as part of a physical examination.
- Retractile testicles. Your doctor will
see if he can gently move the testicle into the scrotum with his hand. If they
can do that, then it's a retractable testicle.
What problems can this cause?
An undescended testicle is associated with a number of conditions:
- Problems with fertility. Because sperm need
to be slightly colder than the rest of the body, an undescended testicle can
cause fertility issues. It's more of a problem when both are stuck in the
groin. Early treatment can make a big difference.
- Hernia. This is a condition in which part of the intestine protrudes through the muscles of the lower abdomen.
- Injury, damage. When the testicle
is out of place, it is more susceptible to damage.
- Cancer. Men with an undescended testicle are slightly more likely to develop testicular cancer, even if they have had surgery to treat it. But surgery allows for routine self-examinations, so if cancer does appear, it can be detected early.
- Testicular torsion. This is when the
umbilical cord, which carries sperm to the penis, twists. This is painful and
can cut off blood flow to the testicle.
Treatment
Very often, the testicle is in place after a few months. At first,
you'll want to wait and see how things go with regular checkups. If it does not
reach the scrotum after 6 months, the doctor will likely suggest surgery.
Surgery is the most common treatment, and it almost always works. This
is usually done when the baby is 6 to 12 months old to get the most benefit
from it. Early treatment can reduce your boy's chance of having fertility
problems later in life.
Your child is given medicine to keep him from waking up and feeling pain
during the procedure. Doctor:
- Make a small opening in either the groin or lower belly to find the testicle.
- Gently move the testicle down.
- Make a small cut in the scrotum and stitch the testicle into place.
- Close the openings with stitches that dissolve on their own.
If there are no complications, your child will go home the same day.
Your doctor will likely suggest pain medication for the first two days. You
will need to keep the area dry and make sure your child avoids things that can
irritate them, such as rolling toys.
An undescended testicle can also be treated with hormones. Although this is not a typical treatment. It usually doesn't work as well as surgery and there may be side effects.