Testicles are formed in the abdomen prior to birth and descend through the groin and into the scrotum during the course of the mother’s pregnancy. An undescended testicle is one that fails to descend into the scrotum prior to birth.
The incidence of undescended testicles in a full-term baby boy is 3 percent but can be as high as 25 percent to 33 percent in a preterm or premature boy. About one-half to two-thirds of the testicles that are initially in the groin may descend into the scrotum, usually within the first few months of life.
Why is it important for testicles to descend?
The testicle is most healthy when it resides in the scrotum because the body temperature is slightly cooler there. Testicles that are undescended and not in the scrotum can undergo changes, especially if they remain high (above the scrotum) and are not corrected prior to puberty. This can have an effect on later hormone production and fertility, especially in those cases where both testes are undescended.
There is also a slightly higher incidence of tumors of the testis later in life. Testes that are not normally-positioned in the scrotum are more challenging for the patient to self-examine or for the primary care provider to check on routine physical exam.
What can be done if my son has an undescended testicle?
The child’s primary care provider should examine the size and location of the testes at each well-child exam. If one or both of the testicles have not descended into a normal location in the scrotum by the time the child is 6-months-old (corrected for gestational age in premature babies), the chances of the testis coming down on its own in the future is very low. If the testicle(s) does not descend into the scrotum, surgery is recommended within the next year.
A child should be referred to a surgical specialist like a pediatric urologist if an undescended testis has not descended into the scrotum by this time. Many of these procedures can be done with spinal anesthesia, eliminating the need for sedation or general anesthesia.
What does surgery accomplish?
The purpose of surgery to relocate the testis into the scrotum is to preserve the function of the testis and to make the exam of the scrotum easier for the patient and physician to check for any future abnormalities. This surgery is generally an outpatient procedure which is well-tolerated by the patient, although testicles that are located higher in the abdomen may require more extensive surgery or multiple procedures. Occasionally, an abnormal or nonfunctional testis (aka remnant or nubbin) is found during surgical exploration and this may require removal as opposed to relocation into the scrotum.
Is surgery always necessary?
In toddlers and young children, there can be an overactive muscle reflex of the muscle fibers which may cause the testis to move during the course of a day (mimicking an undescended testis), but these “retractile” testes can be manipulated into the scrotum once the muscle reflex is relaxed during an exam.
Truly retractile testes (as opposed to undescended testes) are a normal physiologic variant and do not require surgery, but should be monitored closely by the primary care provider as the child grows.
For more information about Nationwide Children's Hospital’s Urology services, click here.
Seth Alpert, MD is an attending surgeon in the Section of Urology at Nationwide Children’s Hospital and Clinical Associate Professor of Urology at The Ohio State University Medical Center.
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