Sometimes, testicles do not come all the way down into the scrotal sac. If testicles do not come down by age one, surgery may be needed. Most boys with undescended testes also have a hernia on the affected side that needs to be repaired.
Testicles (testes) typically descend or drop into the scrotal area during the latter part of pregnancy, in response to the baby’s hormones. The testicles make sperm and the male sex hormone testosterone. The scrotum allows the testicles to be in a cooler environment than the body because sperm cannot develop at body temperature. If the testicles do not descend into the scrotum, sperm do not mature. The longer this lasts, the lower the chances sperm will mature normally.
Undescended testicles occur in about 3% of newborns (and up to 21% of premature newborns). About half of these testicles will descend on their own during the first 6 to 12 months of life. Testicles will not descend spontaneously after 12 months of age. As a result, about 1 to 2% of boys need treatment.
Increasingly, many boys are being diagnosed with an undescended testicle later in childhood, often between 6 and 10 years of age. These boys had normally descended testicles as infants. This condition is called an ‘ascending testicle.’ Many in the medical community think the spermatic cord does not grow normally as the child grows, and the testicles gradually become undescended. These testicles need surgical treatment to move the testicle into the scrotum.
Do not confuse undescended testicles with ‘retractile’ testes. After about age six months, normal babies and male children have a reflex that pulls the testicles up to protect them when he is cold or frightened. These testicles are in the scrotum at other times and do not require any treatment.
- In most children, it is not known why the testicles do not descend.
- Abnormalities to testicles
- Mechanical problem that leads the testicles to descend or drop but miss the scrotum, and end up adjacent to the scrotum (called “ectopic testicles”).
- Insufficient hormones to stimulate the testicles normally
- Recommended after six months of age
- The time between six and 18 months of age is generally considered best
- Only available treatment option is surgery (orchiopexy)
- Requires general anesthesia
- Baby can almost always go home the same day and usually acts normal within one to two days.
- An incision about an inch long is made in the groin area.
- The testicle is separated from surrounding tissues so it drops easily into the scrotum where it is stitched into place. In some cases, the testicle is too high for this simple operation and more complex procedures (and sometimes even two operations) are needed. Overall, the success rate with surgery is 98%.
- If there is a hernina, it is fixed during surgery.