Normally, testicles move from the abdomen to the scrotum just prior to birth. In some boys, one or both testicles will remain in the abdomen or above the scrotum. Other times, there may be a blockage, or the affected testicle may have shriveled due to something that happened during the normal dissension process.
If what appears to be an undescended testicle occurs in infants to pre-adolescent boys, it may be due to a testicle that’s moving back and forth between the scrotum and groin (retractile testicle). In some instances, a testicle will return to the groin, although this is rare.
Symptom and Signs
Boys generally do not experience any discomfort or pain from an undescended testicle. If the abnormality is visually detected, it may correct itself. It’s when there is no visible sign that the undescended testicle has moved into the correct position that further evaluation becomes necessary.
Diagnosis and Treatment
A doctor may notice an undescended testicle during the normal examination that takes place shortly after birth. Diagnosis usually involves a laparoscopy done through a small abdominal incision to find the undescended testicle. Sometimes, open exploratory surgery is done with a larger incision in the abdomen. Image tests are generally not performed.
Treatment typically involves the surgical manipulation of the testicle into the correct position (orchiopexy). This can be done with a traditional open procedure or laparoscopically. The repositioned testicle is then sewn into place.
Following surgery, boys are usually monitored periodically or evaluated during standard childhood physical exams. Ultrasound imaging is sometimes done later to confirm that the testicle is still in the correct position. Hormone levels may also be checked with blood tests.
A possible alternative to surgery is injections of the hCG (human chorionic gonadotropin) hormone. The purpose is to induce the undescended testicle to move on its own. However, success rates aren’t as high as surgery.
When to See a Urologist
Initially, it’s recommended that parents take a wait-and-see approach if an undescended testicle is discovered. If there is no sign that the “missing" testicle has shifted after about 4-5 months post-birth, it’s best to see a specialist. If a testicle that has not shifted into place goes untreated, it may increase the risk of the patient developing testicular cancer or having problems with fertility later in life.
Having a family history of genital abnormalities of the testicles can increase the odds that a baby boy will be born with an undescended testicle. Conditions like Down syndrome that can affect fetal development and growth may also be a contributing factor. When the abnormality is corrected, most boys proceed through the normal stages of development without any further issues.