Undescended testes (UDT, or cryptorchidism)

In normal fetal development, the testes (or testicles) first appear in the baby boy's abdomen at approximately the level of the kidney. Then they begin to descend toward the scrotum where they typically "arrive" by 36 to 38 weeks. But in UDT, the descent is somehow blocked. Sometimes UDT is seen with other anomalies especially those involving the anus and rectum or the genital and urinary tracts.

Incidence

UDT appears in about 1% of males and is also more commonly seen in premature infants than in those who are full term. It is also associated with hormonal disorders, spina bifida, and other abnormalities present at birth.

Signs and symptoms

Finding an empty scrotum and an inguinal lump are the obvious signs. The undescended testis may be located in the inguinal canal, within the abdominal cavity, or in another location, but in approximately 80% of cases, it is found within the inguinal canal. Ten percent of cases involve both testes.

Furthermore, the testes cannot be brought into the scrotum with external manipulation. (It is important to know if the testis was seen or felt in the scrotum at any time. And if the testes can be brought down into the scrotum, the diagnosis of UDT is ruled out.)

The examination must be performed in a comfortable and warm environment. Visual inspection is particularly helpful, since sometimes even touching the child's lower abdomen, upper thighs or genitalia may cause the testes to retract out of the scrotum.

Treatment

Unless both testes are absent, UDT can be addressed when the baby has passed his first birthday. However, if the child needs surgery for a hernia repair, which occurs in many cases, the UDT should be corrected at the time of the hernia surgery. Definitive correction of UDT is best done between 1 to 2 years of age. By that time, delayed descent can be noted, precise examination is easier to perform, and a period of observation by parents and pediatricians will determine that the problem is UDT rather than retractile testis. Delay beyond two years of age is not recommended.

Postoperative care

The purpose of postoperative visits is to check wound healing, presence of infection or bleeding, and to follow the size and position of the testicle. Parents and the child's pediatrician are instructed to examine the child regularly.

Outcomes

In most cases, the procedure has excellent results. Of interest is the fact that fertility after surgery for UDT is 95%, but only 70% for bilateral (involving both testes) UDT. The risk of testicular malignancy in patients with a history of cryptorchidism is 5-10 times greater than the normal population. The risk is greater for bilateral cryptorchidism and intra-abdominal testes.