The testicles form in the abdomen of the unborn baby and move down into the scrotum before birth. When they do not complete this journey, one or both testicles stay in the abdomen or the groin – this is an undescended testicle, or cryptorchidism, the most common congenital abnormality of the genitals in boys. It affects roughly one to three in every hundred full-term newborns and a considerably larger share of premature babies.
In many babies the testicle comes down on its own during the first few months. If this has not happened by six months of age, waiting does not help, and timely surgery preserves the function of the testicle and future fertility. Dr Penev sees boys with an undescended testicle in Plovdiv and Karlovo and helps parents choose the right time for treatment.
What is cryptorchidism
An undescended testicle can be in the abdomen, in the groin canal (inguinal canal) or just above the scrotum. It has been in the wrong position since birth (congenital cryptorchidism) or “moves up” later because the spermatic cord does not grow along with the child (acquired cryptorchidism). The urologist distinguishes a palpable testicle, which can be felt in the groin, from a non-palpable one, which is in the abdomen, very small or absent – what happens next depends on this.
A retractile testicle is a different condition: it has come down normally, but with cold, fear or touch the cremaster muscle pulls it up. It can be brought down into the scrotum by hand and stays there – a variant of normal that is monitored but not operated on.
Symptoms
Cryptorchidism does not hurt and the child does not complain. The signs are noticed by the parents or the paediatrician:
- one or both halves of the scrotum are empty, smaller and have smooth skin;
- the testicle can be felt in the groin but cannot be brought down or immediately goes back up;
- a swelling in the groin if there is a hernia as well.
When it is urgent: sudden severe pain and swelling in the groin or scrotum in a child with an undescended testicle may mean testicular torsion or a trapped (incarcerated) hernia. Do not wait for an appointment – go straight to an emergency department or call 112 (the European emergency number).
Causes and risk factors
The exact cause usually remains unknown. Incomplete descent is linked to premature birth and low birth weight (the main risk factor), cryptorchidism in the father or a brother, complications and smoking during pregnancy and, in a small number of children, genetic and hormonal syndromes.
Diagnosis
The main method is a careful examination in a warm room with the child calm. During a paediatric urology consultation, Dr Penev establishes whether the testicle can be felt, where it is, how big it is and whether it can be brought down into the scrotum and stay there; he also checks for a hernia or a hydrocele.
Ultrasound helps in overweight boys and when the testicle is in the groin canal, but it cannot reliably rule out a testicle in the abdomen and does not replace the examination. For a non-palpable testicle the standard is diagnostic laparoscopy – looking inside the abdomen through a small incision, during which the testicle is usually brought down in the same operation.
Treatment
Watchful waiting until six months
In congenital cryptorchidism, doctors wait until six months of age (corrected for the due date in premature babies), because until then the testicle may come down on its own. After that, surgery is planned; hormone treatment to bring the testicle down is not routinely recommended.
Orchidopexy
In orchidopexy the testicle is freed from adhesions, the spermatic cord is lengthened and the testicle is fixed in the scrotum. For a palpable testicle the operation is done through a small incision in the groin, and for a testicle in the abdomen, laparoscopically. The recommended age according to European guidelines is between six and twelve months, and at the latest by eighteen months. The procedure is done under general anaesthetic, usually as a day case.
In young children the operation is performed in a specialist paediatric surgical unit; Dr Penev makes the diagnosis, decides on the timing, refers the family and follows the child up afterwards at his practice in Plovdiv. If a testicle in the abdomen is found after puberty, removing it may be discussed because of the increased risk of a tumour.
When to see a urologist
Seek a consultation if the paediatrician has noted that the testicle cannot be felt or sits high, if the scrotum looks empty on one side or if an older boy complains that his testicle “disappears”. Untreated cryptorchidism is one of the established causes of male infertility and increases the risk of testicular cancer; early surgery reduces both risks.
Prevention
Congenital cryptorchidism cannot be prevented, but its consequences can. Checking the testicles at birth, during the first year and once a year after that detects the problem in time.
An undescended testicle is treated successfully when it is found and operated on in time. If you have any doubts about the position of your child’s testicles, book an appointment with Dr Penev for an examination and a clear plan.
Frequently asked questions
Can the testicle come down on its own after the first year?
After six months of age (corrected for the due date in premature babies), it is very unlikely to come down on its own. Waiting beyond this age brings no benefit, and as treatment is delayed the germ cells of the testicle are gradually damaged.
Do hormone injections help instead of surgery?
Hormone treatment has a low and often temporary effect, and current European guidelines do not recommend it as the main method for bringing the testicle down. The standard is surgery, and hormones are considered only in individual cases.
Is the operation painful, and how long does my child stay in hospital?
Orchidopexy is done under general anaesthetic, so your child feels nothing. In most cases he goes home the same day or the next day, and any discomfort afterwards is controlled with ordinary painkillers.
My son is eight and his testicle moves up – is that a problem?
A testicle that retracts with cold or touch but comes back down by itself and stays in the scrotum is retractile and is usually not operated on. But if it can no longer be brought down or stays up permanently, this is acquired cryptorchidism, which is treated with surgery.
Is follow-up needed after the operation?
Yes. A follow-up check is done a few weeks after the operation and again about six months later to check the position and size of the testicle. In adolescence the boy is taught to examine himself, as the risk of a tumour remains slightly higher.
The information on this website is for general education and does not replace an examination and consultation with a doctor. If you have urgent symptoms, seek medical help immediately or call 112.