UNDESCENDED TESTICLES (CRYPTORCHIDISM)

During gestation, the testes develop in the abdomen of the male fetus. As he nears birth, they descend through a tube (the inguinal canal) into the scrotum. In a small number of boys, especially those who are premature, one or both testicles fail to descend by the time of birth. In many of these boys, descent will occur during the first nine months of life. In some, however, this does not happen.

All boys will have normal elevation of testes under certain situations, such as sitting in cold water. However, under normal conditions, testes should be low in the scrotum.

Factors Causing Undescended Testicles

The cause of undescended testicles cannot be explained in most cases. However, in some boys the following factors may play a role:

· There may not have been enough of certain hormones from the mother or the developing testicles to stimulate their normal maturation.

· The testes themselves may be abnormal in their response to these hormones.

· There may be a physical blockage that prevents descent.

· In some cases, there may be a link with hormonal preparations taken by the mother during pregnancy (which is one reason why pregnant women are advised to avoid such medications).

If your child has undescended testicles, his scrotum will be small and appear underdeveloped. If only one testicle is undescended, the scrotum may look asymmetrical (full on one side, empty on the other). If the testicles are sometimes present in the scrotum and at other times (such as when he is cold or excited) are absent and located above the scrotum, they are said to be "retractile." This condition usually is self-correcting as the boy becomes more mature.

The undescended testicle may be twisted, and in the process, its blood supply may be blocked, causing pain in the inguinal (groin) or scrotal area. If this situation is not corrected, the testicle can be severely and permanently damaged. So if your son has an undescended testicle and complains of pain in the groin or scrotal area, call your pediatrician immediately.

Undescended testicles should be re-evaluated at each regular checkup. If they do not descend into the scrotum by age 1 to 2, treatment should be started.

Treatment of Undescended Testicles

Undescended testicles may be treated with hormone injections and/or surgery. The lower the testes, the more likely that the hormone injections will be successful. Usually, but not always, treatment with hormones is tried first; if that is unsuccessful, the surgical approach is taken. Sometimes a hernia also is present and can be repaired at the same time.

If your son's undescended testicle is allowed to remain in that position for over two years, he has a higher than average risk of being unable to father children (infertility). He also has a slightly increased risk of developing testicular tumors in adult life, particularly if the testicle is left in its abnormal position. Fortunately, with early and proper treatment, all of these complications can usually be avoided.