Undescended Testes

Undescended testes

Definition

Also known as cryptorchidism, undescended testes is a congenital condition characterized by testicles that do not follow the normal developmental pattern of moving into the scrotum before birth.

Description

In the fetus, the testes are in the abdomen. As development progresses, they migrate downward through the groin and into the scrotum. This event takes place late in fetal development, during the eighth month of gestation. In some newborn boys the testes are not present in the scrotum, either because the testes did not descend or because the testes never developed in the fetus.

Demographics

Eighty percent of all undescended testes cases naturally correct themselves during the first year of life. Only 3 to 4 percent of full-term baby boys have undescended testes, and half of those complete the journey by the age of three months. Up to 30 percent of boys born prematurely have testes that have not yet made the full descent. In 5 percent of cases of undescended testes, the testis on one side is completely absent. In 10 percent of cases, both testes are completely absent.

Causes and symptoms

There are many different and complex reasons why one or both testes may not descend. Sometimes the failure is due to problems that occur during pregnancy with the tissues as they are developing or with hormone levels in the developing fetus. If the testes did not descend because they are absent, then the likely cause is different than for testes that are present but did not descend. In the case of absence, it is possible that the testes never developed at all because the blood flow was cut off to them as they were developing, preventing their formation. One or both of the testicles can be undescended; therefore, the scrotum can appear to be either missing or lopsided.

When to call the doctor

The doctor will check for the testes in the scrotum during the normal newborn examination. If the parent notices that their male infant's testes do not appear normal or do not appear to be present at all, the parent should alert the doctor. If the testes have not descended by the time the child is six months of age, the parent should call the doctor to begin discussing possible treatment options.

Diagnosis

The newborn examination always checks for testes in the scrotum. It they are not found, a search will be conducted, but not necessarily right away. If the testes are present at all, they can be anywhere within a couple inches of the appropriate spot. In most cases, the testes will drop into place later. In 5 percent of cases, one testis is completely absent. In 10 percent of cases, the condition occurs on both sides. Presence of undescended testes is differentiated from absence of testicles by measuring the amount of gonadotropin hormone in the blood.

Treatment

Once it is determined that the testes will not naturally descend, treatment options must be considered. Hormone therapy is a possible treatment but does not have a very high success rate. Another treatment option is surgery. The procedure is called an orchidopexy and is relatively simple once the testes are located. The surgery is usually performed when the boy is between one and two years old.

Prognosis

Of full-term baby boys who have undescended testes, half will descend on their own without intervention by the age of three months. Eighty percent of all undescended testes cases naturally correct themselves during the first year of life. Of those cases that do not correct themselves naturally, intervention is very important, because undescended testes increase the likelihood of sterility and testicular cancer . Undescended testes are twice as likely to develop cancer as normally descended testes. Ten percent of all testicular cancers are in undescended testes. An adult man is three to 17 times more likely to develop testicular cancer if he has had a testis that did not descend naturally. Surgery done to move the testis into the scrotum does not reduce the likelihood of malignancy but allows accessibility of the testes to screen for masses which will allow early treatment. The incidence of testicular cancer in men who did not have both testes descend normally is about 1 in 2000.

Many children who have undescended testes have reduced fertility as adults. It is thought that as many as 50 to 75 percent of children with undescended testes have problems with fertility as adults. Children with undescended testes are also more likely to develop hernias and have problems with their urinary tract.

Prevention

There is no known way to prevent undescended testes.

Parental concerns

Undescended testes are of concern because, although they are not known to be a threat to the child's immediate health, they are associated with an increased likelihood of negative outcomes later in life, including an increased likelihood of sterility and an increased incidence of testicular cancer.

KEY TERMS

Cryptorchidism —Undescended testes, a condition in which a boy is born with one or both testicles in the lower abdomen rather than the scrotum.

Embryonic —Early stages of life in the uterus.

Fetal —Refers to the fetus. In humans, the fetal period extend from the end of the eight week of pregnancy to birth.

Orchiopexy —A surgical procedure that places an undescended testicle in the scrotum and/or attaches a testicle to the scrotum.

Resources

BOOKS

Behrman, Richard E., Robert M. Kliegman, and Hal B. Jenson, eds. Nelson Textbook of Pediatrics. Philadelphia: Saunders, 2004.

Goldman, Lee, and J. Claude Bennett, eds. Cecil Textbook of Medicine. Philadelphia: Saunders, 2004.

Rajfer, Jacob. "Congenital Anomalies of the Testes and Scrotum." In Campbell's Urology, edited by Patrick C. Walsh, et al. Philadelphia: Saunders, 2002.

Rozauski, Thomas, et al. "Surgery of the Scrotum and Testis in Children." In Campbell's Urology, edited Patrick C. Walsh, et al. Philadelphia: Saunders, 2002.

PERIODICALS

Koo, Harry P. "Is It Really Cryptorchidism?" Contemporary Urology (January 2001): 12.

ORGANIZATIONS

American Urological Association. 1000 Corporate Blvd., Linthicum, MD 21090. Web site: <www.urologyhealth.org>.

Tish Davidson, A.M.