Undescended Testicle

A baby's testicle sometimes doesn't move into its correct place in the scrotum (the pouch of skin below the penis) before birth. This is called an undescended testicle, or cryptorchidism. Usually, just one testicle is affected, but sometimes both are.

Premature babies are more likely to have this issue than full-term babies. In many cases, the testicle moves into the right spot on its own within a few months after birth. If the testicle doesn't move down naturally, surgery can be performed to put it in the correct location in the scrotum. This surgery is a common procedure, and it's important to have it done if the problem persists.

A baby's testicles typically develop in the belly and move down into the scrotum before birth. This usually happens during the last few months of pregnancy, as the testicles travel through a passage in the groin called the inguinal canal. Sometimes, this movement is delayed or stops entirely. This is called an undescended testicle.

A doctor will often find an undescended testicle during a newborn checkup. If your baby has an undescended testicle, ask the doctor how often checkups will be needed. If the testicle hasn't moved into the scrotum by around 3-4 months old, it's unlikely to move on its own.

Treating the condition early, while the baby is young, can help prevent potential problems later in life. These problems may include testicular cancer and infertility (difficulty getting a partner pregnant).

In older children (babies to preteens), a testicle that was initially present in the scrotum might seem to disappear later. This could be due to a couple of reasons. One is a retractile testicle. This testicle moves back and forth between the scrotum and the groin. A doctor can often gently guide a retractile testicle back into the scrotum. This is a normal response to muscle reflexes in the scrotum.

The other reason is an ascending testicle, also sometimes called an acquired undescended testicle. This means the testicle has moved back up into the groin and can't be easily pushed back down into the scrotum.

If you notice any changes in your child's genitals or have any concerns, talk to your child's doctor or other healthcare provider immediately.

A baby boy's testicle sometimes doesn't move into the scrotum right away. Doctors often check for this during the first few weeks after birth. If this happens, ask your pediatrician how often they will need to check your baby's testicles.

If a testicle hasn't moved into the scrotum by about 3 to 4 months old, it's unlikely to move on its own. Treating this early can significantly reduce the risk of problems later in life. These problems can include testicular cancer and difficulty having children (infertility).

Sometimes, a boy who seems to have normal testicles at birth might later develop an issue. This can be due to a few reasons:

• Retractile testicle: This means the testicle can move back and forth between the scrotum and the groin. During a check-up, a doctor can often gently push the testicle back into the scrotum. This is a normal reflex in the muscles of the scrotum.

• Ascending testicle (or acquired undescended testicle): This means the testicle has moved back up into the groin. Unlike a retractile testicle, it's not easy to move it back down into the scrotum.

If you notice any changes in your child's genitals or have any concerns at all, talk to your pediatrician or other healthcare provider. Early detection and treatment are important.

Scientists don't know precisely why some babies are born with undescended testicles. It's likely a mix of factors. A baby's genes, their mother's health during pregnancy, and other influences might combine to affect the hormones, physical development, and nerve signals needed for the testicles to move into their proper place. These combined factors may interfere with the normal process of testicle development.

Factors that can increase the chance of a baby being born with an undescended testicle include:

• Premature birth or low birth weight: Babies born early or weighing less than usual are at higher risk. This is because their bodies may not have fully developed the necessary structures for the testicles to move into their proper place.

• Family history: If other family members have had undescended testicles, the risk for the baby is increased. This suggests a possible genetic predisposition.

• Certain health conditions: Some medical conditions in the baby, such as cerebral palsy or a weakness in the abdominal wall, can also affect the development and positioning of the testicles.

• Mother's health: If the mother has diabetes before or during pregnancy, it can impact the baby's development, potentially increasing the risk of undescended testicles.

• Substance use during pregnancy: Drinking alcohol or smoking cigarettes during pregnancy can harm the developing baby and raise the risk of various birth defects, including undescended testicles. Exposure to secondhand smoke also carries risks.

• Environmental exposures: Exposure to some pesticides during pregnancy might also contribute to the risk of undescended testicles. More research is needed to fully understand this connection.

For a man's testicles to develop and function properly, they need to stay slightly cooler than the rest of his body. The scrotum is designed to keep them at this cooler temperature. If a testicle isn't in its normal place in the scrotum, it can lead to several potential health problems.

Increased Risk of Testicular Cancer:

Men who have one or both undescended testicles (meaning they haven't moved down into the scrotum) have a higher chance of developing testicular cancer later in life. This type of cancer often starts in the cells that make sperm, and exactly why these cells turn cancerous isn't fully understood.

The risk of testicular cancer is greater if the undescended testicle is located higher up, near the stomach, than if it's closer to the groin. The risk is also higher if both testicles are undescended. While surgery to move the testicle down can reduce the risk, it doesn't eliminate it entirely.

Fertility Problems:

Undescended testicles can also make it harder for a man to have children. This is because the undescended testicle may not develop as it should, affecting sperm production. If the problem isn't addressed early, fertility issues could become more significant.

Other Potential Complications:

Besides cancer and fertility problems, undescended testicles can increase the risk of other health issues:

• Testicular Torsion: The cord that carries blood to the testicle can twist, cutting off the blood supply. This is a painful condition. Without prompt treatment, the testicle might be damaged enough to require surgery to remove it.

• Inguinal Hernia: A part of the intestines can push through a weak spot in the muscles of the abdomen (stomach area), creating a bulge in the groin. This hernia can be painful and needs medical attention.

In summary, having an undescended testicle can raise a man's risk for several health problems, including cancer, fertility issues, and other conditions. If you have concerns about this, it's important to talk to a doctor.

If a baby's testicles aren't in the right place (scrotum) after birth, surgery might be necessary. There are two main ways surgeons can address this:

Open Surgery: A larger incision (cut) is made in the lower stomach area or groin. The surgeon then looks inside to find the testicle.

Laparoscopy: A tiny camera on a thin tube is inserted through a small cut near the belly button. This allows the surgeon to see inside and locate the testicle.

The surgeon may be able to move the testicle into the correct position during the same procedure. However, sometimes a second surgery is needed. Sometimes, laparoscopy can't find the testicle. Or, it might reveal that the testicle is damaged or not functioning properly. In these cases, the damaged or non-working testicle tissue might need to be removed.

If a testicle can't be found, further tests might be needed to determine if it's actually missing (not just hidden). If a testicle is missing, or if there's a problem with its development, it could lead to serious health issues in the baby.

Usually, tests like ultrasounds or MRIs aren't needed to diagnose an undescended testicle. A physical exam and the laparoscopy or open surgery are usually enough to find out what's happening.