Undescended Testes (Cryptorchidism)

What is cryptorchidism (undescended testes)?

Cryptorchidism (or undescended testes) is a condition seen in newborns when one or both of the male testes have not passed down into the scrotal sac. About 10% of cases involve both testes. Cryptorchidism is more commonly seen in premature males because the testes do not descend from the abdomen to the scrotal sac until the seventh month of fetal development.

What causes undescended testes?

Undescended testes may occur for several reasons. While prematurity is a leading cause, other causes may include hormonal disorders, spina bifida, retractile testes (a reflex that causes a testicle to move back and forth from the scrotum to the groin), or testicular absence.

Who is affected by undescended testes?

According to pediatric urologists (a specialist who treats illness or disease of the genitals or urinary tract):

  • Undescended testes occurs in about 3% to 5% of male infants.

  • Up to one-third of premature male infants have an undescended testis.

  • There is also a genetic component: 14% of males with undescended testes also had a male relative with the condition.

  • In rare cases, boys who undergo an inguinal hernia repair may develop undescended testes.

What are the symptoms of undescended testes?

Being unable to feel the testes on examination is the most common symptom of cryptorchidism. Symptoms of cryptorchidism may look like other conditions or medical problems. Always consult your child's doctor for a diagnosis.

How are undescended testes diagnosed?

Diagnosis of undescended testes is made based on a complete medical history and physical exam. Your child's doctor will evaluate the child's scrotum for undescended testes at every well-child check.

What is the treatment for undescended testes?

Many cases of undescended testes resolve on their own by 3 months of age.  Most resolve by one year without any treatment. In these cases, the testicles (or testes) descend from the inguinal canal into the scrotal sac on their own.

Your child’s health care provider will figure out the best treatment based on:

  • How old your child is

  • His overall health and medical history

  • How sick he is

  • How well your child can handle specific medications, procedures, or therapies

  • How long the condition is expected to last

  • Your opinion or preference

Treatment may include:

  • Hormonal therapy. Certain hormones may stimulate the production of testosterone, which helps the testes descend into the scrotal sac. This is not routinely used for treatment of truly undescended testes.

  • Surgical repair. A surgical repair to locate the undescended testicle and move it to the scrotal sac may be recommended by your child's doctor. This surgery, called orchiopexy, is usually done between months 6 and 18 and is successful in 98% of children with this condition.

If cryptorchidism is not repaired, the following complications may occur as your child grows and matures:

  • Infertility (most common where both testes are affected)

  • Risk of testicular cancer increases considerably by age 30 or 40

  • Inguinal hernia (a weakened area in the lower abdominal wall or inguinal canal where intestines may protrude)

  • Testicular torsion (a painful twisting of the testes that can decrease blood supply to the testes)

  • Psychological consequences of an empty scrotum

Health care providers should share information about potential long-term risks for infertility and cancer risk. Men with a history of this condition will need to do monthly self-testicular exams.

Please consult your doctor with any questions or concerns you may have regarding this condition.