What is an undescended testicle? What are the diagnostic and treatment methods?

Undescended testis (cryptorchidism) is a condition in which one or both testes fail to descend into the scrotum after birth. This condition is usually noticed during infancy and is one of the most common urological problems in boys. If left untreated, it can increase the risk of infertility, hormonal disorders, and testicular cancer later in life, making early diagnosis and treatment extremely important.

What is an undescended testicle?

Undescended testicles, also called cryptorchidism, is the condition in which one or both testicles fail to descend into the scrotum (testicle) after birth in male infants. Normally, the testicles develop in the abdominal cavity during fetal development.

As birth approaches, these testicles pass through the inguinal canal and implant in the scrotum. This process may be completed within the first few months after birth. However, in some babies, the testes may remain in the abdomen, in the inguinal canal, or, rarely, in a different location instead of the scrotum.

Undescended testicles, the most common congenital problem in male children, is most often seen in premature babies. In most cases, the testicles descend spontaneously into the scrotum within the first 6 months after birth; however, if they remain undescended after this time, medical intervention may be necessary. This is because this condition is not only an aesthetic problem but also carries an increased risk of infertility, hormonal problems, and testicular cancer in later life.

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What are the causes of undescended testicles?

While the exact cause of undescended testicles is not always clear, it is thought that hormonal, genetic, environmental, and anatomical factors during pregnancy all play a role.

The normal descent of the testicles occurs during fetal development under the influence of certain hormones (especially testosterone and gonadotropins). In this normally functioning process, the testicles descend into the scrotum either shortly before birth or at the latest within 6 months after birth. However, due to hormone deficiency or disorders, the descent process may not be completed.

Certain genetic abnormalities can also cause this problem. Children with a family history of undescended testicles are at higher risk. In addition, narrowing of the testicular descent pathway, abnormalities in the inguinal canal or in the testicle itself can prevent the testicle from reaching the scrotum.

Since the descent of the testicles is usually completed in the later months of pregnancy, premature babies have a much higher risk of undescended testicles. The incidence of undescended testicles may also increase in twin or triplet pregnancies and in babies with low birth weight.

What are the symptoms of undescended testicles?

Undescended testicles are usually detected during a routine examination shortly after birth. This is because babies generally do not experience pain or other symptoms. Therefore, families are often alerted not by themselves, but by a pediatrician, pediatric surgeon, or urologist. Parents can check their child's testicles manually. The main signs to look out for are:

• The inability to feel the testicle in the scrotum (sac).
• Asymmetrical appearance
• A palpable mass in the groin or abdomen.

How to Recognize Delayed Undescended Testicles?

Delayed undescended testicles are most often identified by the absence of the testicle in the scrotum. Families or doctors may not be able to feel the testicle in the scrotum during examination. In this case, the scrotum may appear empty or asymmetrical. In some children, the testicle may remain in the groin area or inside the abdomen.

Undescended testicles, which often go unnoticed until puberty, manifest as developmental delay in the affected area, small testicular size, and an irregular scrotum. Because failure to diagnose early can increase the risk of infertility and testicular cancer later in life, children suspected of having late-stage undescended testicles should be evaluated by a specialist physician.

How is undescended testicle diagnosed?

Undescended testicles are usually diagnosed through a physical examination. However, the diagnostic process can vary depending on the location of the testicle, the child's age, and whether the condition is unilateral or bilateral.

During a physical examination, the presence of the testicles in the scrotum is assessed during routine checkups of newborns and infants. The doctor attempts to palpate (feel) the testicle in the scrotum. If the testicle is located in the groin or abdomen, it may be felt as a hard mass.

Sometimes the testicle can temporarily move upwards due to muscle contraction; this is called a retracted testicle and needs to be distinguished from an undescended testicle. If the testicle is hidden in the abdomen or inguinal canal, it cannot be felt by hand. In this case, imaging tests may be requested. Laparoscopy can determine the location of a testicle that cannot be found in its proper place or in the groin.

How is an undescended testicle treated?

Treatment for undescended testicles is usually surgical. Monitoring may be possible for the first six months, during which the testicle is expected to descend spontaneously. However, if no improvement is seen, surgical treatment is considered. In some cases, hormone therapy may also be used, but its success rate is low.

Surgical treatment (orchiopexy) involves lowering and fixing the testicle into the scrotum under general anesthesia. The operation usually takes around 30-60 minutes. The patient is generally discharged the same day, but the child's testicles are monitored for a year.

Frequently Asked Questions About Undescended Testicles

Until what age can undescended testicles remain undescended?

It usually descends spontaneously within 6 months of birth; if it doesn't, surgical intervention is required.

Does an undescended testicle affect sexuality?

If left untreated, it can negatively affect sexual function in later years.

Is an undescended testicle harmful?

Yes, if left untreated, it increases the risk of infertility and testicular cancer.

Do undescended testicles produce sperm?

Sperm production is often impaired, and the risk is higher if both testicles have not descended.

Is it possible to have a son with only one testicle?

Yes, as long as a single healthy testicle can produce normal sperm, a man can have children.

What does an undescended testicle look like?

The testicle may not be visible in the scrotum, or one side may appear empty.

Can undescended testicles be corrected?

Since spontaneous recovery is unlikely, surgical treatment is often necessary.

How to tell if a testicle is undescended?

This is detected during examination when the testicle is not felt in the scrotum.