Undescended Testes in Children

Overview

Undescended testes means that 1 or both of the male testes have not passed down (descended) into the scrotal sac. This is a condition seen in some newborn baby boys. Most cases affect only 1 teste. About 1 in 10 cases affect both testes. This condition is more common in boys born preterm or small for gestational age. Treatment is needed.

Causes

Undescended testes are more often seen in babies who are born early (preterm or premature babies). This is because the testes don’t pass down from the belly into the scrotal sac until month 7 of a baby’s growth in the uterus. Other causes may include hormone problems or spina bifida.

It may be caused by a reflex that causes a testicle to move up and down from the scrotum back into the groin (called retractile testes). In some cases, the testes are missing. In rare cases, a boy who has inguinal hernia repair may develop undescended testes.

Undescended testes is not the same as retractile testes. This is when the testes are present but easily draw back (retract) into the inguinal canal. This might happen if the testes are exposed to cold temperature.

Retractile testes often do not need any further evaluation or treatment. Undescended testes do need treatment.

Risk Factors

This condition occurs in about 3 in 100 to 1 in 20 male babies. A baby is more at risk if they:

Are born before 37 weeks of pregnancy (preterm)
Are small for gestational age
Are low birth weight
Have a family member with the condition

Symptoms

Symptoms can be a bit different in each child. The most common sign is when a healthcare provider can’t feel the testes during an exam. Most children don't have symptoms when they have an undescended testicle.

Diagnosis

The healthcare provider will ask about your child’s symptoms and health history. They may also ask about your family’s health history. Your child's provider will examine your child's scrotum for testes at every well-child check. In some cases, imaging tests, such as ultrasound or MRI, are needed to find the testicles within the pelvis. But this is often not needed.

Treatment

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how bad the condition is. In many cases, the testes descend on their own into the scrotum by age 3 months. In most cases, the testes pass down by age 6 months without any treatment.

In other cases, treatment may be needed. This may include:

Surgery. The undescended testicle may be moved into the scrotal sac with surgery. This surgery is called orchiopexy. It’s often done between ages 6 and 18 months. It works for most children.

Talk with your child’s healthcare provider about what kind of treatment is advised for your child.

Complications

If testes don’t descend, this can cause problems, such as:

Infertility. This is most common when both testes don’t descend.
Risk for testicular cancer. This risk increases greatly by age 30 or 40. Men with undescended tests will need to do monthly testicular self-exams.
Inguinal hernia. This is a weakened area in the lower belly wall or inguinal canal where intestines may push through.
Testicular torsion. This is a painful twisting of the testes that can decrease blood supply to the testes.
Emotional stress. An empty scrotum can cause emotional upset to boys and men.

When to Call a Healthcare Provider

Call the healthcare provider if your baby has no sign of testes in his scrotal sac.

Key Points

Undescended testes means that 1 or both of the male testes have not passed down into the scrotal sac. This is a condition seen in some newborn baby boys.
A baby is more at risk if they are born before 37 weeks of pregnancy (preterm). Or if they have a family member with the condition.
In many cases, the testes descend on their own into the scrotum by 3 months old. In most cases, the testes descend by age 6 months without any treatment.
In other cases, surgery may be needed.
If testes don’t descend, this can cause problems such as infertility, higher risk of testicular cancer, and other problems.

Next Steps

Tips to help you get the most from a visit to your child’s healthcare provider:

Know the reason for the visit and what you want to happen.
Before your visit, write down questions you want answered.
At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
Ask if your child’s condition can be treated in other ways.
Know why a test or procedure is recommended and what the results could mean.
Know what to expect if your child does not take the medicine or have the test or procedure.
If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
Know how you can contact your child’s healthcare provider after office hours, and on weekends and holidays. This is important if your child becomes ill and you have questions or need advice.