Undescended testicles in children

What are undescended testicles (cryptorchidism)?

Undescended testicles (cryptorchidism) is a common condition present from birth, where one or both testicles have not moved into the scrotum as expected. During development, the testicles form in the abdomen and usually descend into the scrotum before birth. In some babies, this process does not complete, and the testicle may remain in the groin or abdomen.

If the testicles have not descended by around three months of age, specialist assessment is recommended. In many cases, the testicle can be felt in the groin and treated with a straightforward surgical procedure to move it into the scrotum. Where the testicle cannot be felt, minimally invasive (keyhole) surgery may be used to locate it within the abdomen. Some children may require staged procedures to achieve the best outcome.

At Evelina London Children’s Hospital, our specialists provide expert assessment and treatment for undescended testicles as part of our children’s urology service.

Undescended testicles symptoms

It’s estimated that around 1 in every 25 boys is born with at least one undescended testicle. In many cases, there’s no need for treatment, as the testicles will descend naturally within the first three months after a baby is born.

An undescended testicle is usually detected by not seeing or feeling a testicle where it should be in the scrotum. It doesn’t tend to cause any other noticeable symptoms.

For this reason, most cases are detected shortly after birth when your baby is given a physical examination.

How to check for undescended testicles

The best way to check for an undescended testicle is with a physical examination. Your doctor should be able to gently palpate (examine by touch) the scrotum to feel the testicle inside.

If this is missing, or there are any unusual swellings that don’t feel right, it’s a good idea to get it checked by a specialist.

What causes undescended testicles?

So, what causes undescended testicles (also known as cryptorchidism)? Unfortunately, in most cases, it’s not known why some children are born with undescended testicles and others aren’t.

However, research has shown that babies who are born prematurely (before 37 weeks gestation) are more likely to be affected.

Complications of cryptorchidism

Children who have undescended testicles and don’t have treatment are at greater risk of experiencing several complications. One of these is fertility problems. This is because undescended testicles that aren’t brought into the scrotum at a young age may not produce good sperms.

Undescended testicles have also been associated with an increased risk of testicular cancer. In fact, people with undescended testicles are three times more likely to develop testicular cancer than those whose testicles descended either at birth or shortly after. Unfortunately if diagnosis of pathology (like cancer) is often delayed if the testis are not in the scrotum as they are not easy to feel.

Some children have what is known as a retractile testicle. This is where the testicle moves back and forth between the scrotum and groin and occurs due to a muscle reflex. This is fairly normal and over time, the testicles should settle into a permanent position in the scrotum.

Hypospadias and cryptorchidism

Some studies have suggested that undescended testicles, alongside a condition called hypospadias, are signs of something known as testicular dysgenesis syndrome — a health concern that can impair fertility.

Hypospadias is a birth defect in which the opening of the urethra isn’t located at the tip of the penis. Instead, it is usually found on the underside of the penis, or occasionally between the anus and scrotum. Again, this is a problem that occurs during fetal development and isn’t usually detected until the baby is born.