Undescended Testicle – Diagnosis and Treatment
Diagnosis
Doctors often detect an undescended testicle soon after birth during a routine check of the baby boy’s genitals. They check the scrotum to see if both testicles are in their normal position.
If one or both testicles are missing from the scrotum, doctors may locate them in the groin or abdomen. Sometimes they can feel the testicles, but in other cases, they cannot touch or locate them (nonpalpable testicle).
Babies born early (preterm) or with a low birth weight have a higher likelihood of this condition.
Doctors may use the following steps for diagnosis:
- Physical Exam: Checks for the presence and position of testicles in the scrotum, groin, or inguinal canal.
- Laparoscopy: A thin tube with a camera goes into the abdomen to locate a hidden testicle.
- Open Surgery: A larger cut helps to identify testicles not found by other methods.
Doctors rarely use imaging tests like ultrasound or MRI. If both testicles are absent, they conduct further evaluation to see if the testicles never developed or if they are ectopic.
Early diagnosis supports healthy testis development and future fertility. The examination checks for conditions that could impact Sertoli cells and Leydig cells, which are important for hormone production.
Treatment
Surgical Procedures
Surgeons correct an undescended testicle primarily through surgery. A specialist, often a pediatric urologist, moves the testicle into the scrotum and holds it in place with stitches.
This operation is called orchiopexy or sometimes orchidopexy. Doctors usually recommend surgery between 6 and 18 months of age to reduce risks later in life, such as infertility or testicular cancer.
The surgeon makes a small cut in the groin or scrotum. If dead or non-working tissue is present, the surgeon removes it. Some children might also have an inguinal hernia—a weak spot in the belly wall—fixed during the same operation.
Afterward, doctors monitor the testicle using:
- Physical checkups
- Ultrasound imaging
- Hormone blood tests
Children with certain genetic conditions, like Prader-Willi syndrome, might need extra care during surgery.
Hormonal Medicine
Doctors may sometimes try hormone shots as an alternative to surgery. The medicine, called human chorionic gonadotropin (hCG), encourages the testicle to drop down into the scrotum.
However, this method works less often than surgery. Many doctors do not recommend it as a first choice because it has a lower chance of success and does not always fully solve issues related to fertility or the risk of testicular tumors.
Options When There’s No Testicle
For children with a missing or removed testicle, doctors offer other solutions. Testicular prostheses are artificial implants that make the scrotum look more typical.
Doctors can place these with a simple surgery, often after puberty or at least six months after the first operation.
If both testicles are absent or don’t function, an endocrinologist (hormone doctor) may provide hormone therapy to start puberty and support normal development. These therapies help with body changes related to testosterone.
A testicular biopsy can confirm if tissue is normal or contains changes related to problems like germ cell neoplasia or testicular malignancy.
What to Expect after Treatment
Orchiopexy almost always succeeds for one undescended testicle, with a success rate near 100%. Boys who have this surgery on one testicle will likely produce normal sperm and have normal fertility later.
The chance of infertility increases if both testicles were undescended, but surgery may still improve outcomes.
Surgery might decrease—but does not remove—the chance of testicular cancer. There is still some risk of developing a tumor or other complications, such as subfertility or vanishing testis.
Everyday Tips and At-Home Care
Caregivers should regularly check the position of their child’s testicles, especially during activities like diaper changes or baths. This helps ensure the testicles are growing as expected.
As children get older, parents or guardians can talk with them about how their bodies will change. When puberty approaches, teaching teens how to do a testicular self-exam is important.
This monthly check lets them notice any lumps or changes early. If a teenager feels something unusual during a self-exam, contacting a healthcare provider for advice is best.
Ways to Manage and Find Support
Children with a retractile testis or retractile testicle might sometimes feel worried about looking different, especially in places like locker rooms. Parents and caregivers can help by talking openly and giving honest answers.
Teaching children clear and age-appropriate words to talk about the scrotum and testicles can make conversations with others easier and help reduce confusion or embarrassment.
Support can also come by using these ideas:
- Use simple explanations. Share that most people have two testicles, but having only one, or a retractile testis, does not mean a child is unhealthy.
- Talk about choices. Discuss the idea of a testicular prosthesis if the child or family wants it for comfort or appearance.
- Practice answers. Help the child get ready to answer questions from peers or respond to bullies with short, honest explanations.
- Choose clothing wisely. Loose boxers and swim trunks may help make a retractile testicle less noticeable.
- Watch for signs. Notice if the child avoids activities or seems worried, which could mean extra support is needed.
Ongoing encouragement, patience, and open communication help children feel secure and confident.
Getting Ready for Your Visit
What the Doctor Will Do
During the appointment, the health care provider performs a physical exam. They look at the groin and scrotum to check for the testicle.
Sometimes, the provider gently presses the area using a lubricant or warm, soapy water. This helps make the exam more comfortable and helps them find the testicle.
If the testicle can be felt but does not move easily into the scrotum, or if it causes pain, it might be an undescended testicle. Sometimes, the testicle moves down but returns quickly to its previous spot.
If it stays in place after gentle movement, it could be a retractile testicle, which is usually less concerning.
Doctors check if both testicles are present by birth and continue to observe during regular baby checkups. If the testicle still has not moved into the scrotum by about 6 months of age, the provider might suggest seeing a pediatric urologist.
A pediatric urologist cares for children’s urinary and genital health. In some cases, a pediatric surgeon may provide further help.
Parents and guardians can bring notes or a list of specific questions. Questions can focus on how often to come back for checkups, how to safely check at home, what tests are needed, and what treatment is best.
Table: What Might Happen During the Visit
| Action | Purpose |
|---|---|
| Physical exam | To locate the testicle and check its position. |
| Use of lubricant | To make the exam more comfortable. |
| Gentle movement | To see if the testicle can be moved into the scrotum |
| Advice on next steps | To plan for specialist care, if needed. |
Parents or guardians should ask anything they are unsure about so they feel confident in the care plan.
