What Is Undescended Testis? What Causes It? How Is It Treated?

Undescended testes, characterized by the testes not being in their normal position, are a common childhood condition affecting approximately 1 in every 25 children. Not every child born with an undescended testis problem requires treatment. In some cases, the testes may descend on their own within a few months. However, if the testes do not descend within a few months after birth, certain complications may develop later on. Early diagnosis and treatment can help prevent the long-term complications of undescended testes.

Questions such as “What causes undescended testis?” and “How is it diagnosed, and what are the diagnostic methods?” Questions like these, along with other common concerns about undescended testis, are addressed in detail later in this article.

What Is Undescended Testis?

The testes, which are important parts of the male anatomy, have one of their key functions in producing hormones and sperm. Normally, male babies are born with two testes, and the testes begin to develop while the baby is still in the womb. Before birth or shortly after birth, the testes descend into the scrotum, a pouch located beneath the penis. A certain temperature range is required for the production of sperm, the male reproductive cell. The human body temperature of 37 degrees does not provide a suitable environment for sperm production. Therefore, in males, the testes responsible for sperm production must be located and kept inside the scrotum, which is on the outside of the body.

One of the most important functions of the scrotum is to keep the testes at a temperature of 35.5–36 degrees. However, in some cases the testes cannot complete their descent into the scrotum as they should. In most cases of undescended testis, only one of the testes has not descended into the scrotum, while in some cases neither is located within the scrotum. The undescended testis problem, also called cryptorchidism in medical literature, is a congenital anomaly seen in about 3% of babies. Studies show that this rate may be higher in premature babies.

What Are the Symptoms of Undescended Testis?

The most important sign of an undescended testis is that the testis cannot be seen or felt in the scrotum. Approximately 80% of undescended testis cases are noticed during a physical examination by a doctor. Normally, the testes are located in the scrotum, the pouch on either side of the penis, at the end of the inguinal canal. On the side where the testis is undescended, the scrotum usually appears smaller compared to the other side.

What Causes Undescended Testis?

The process that ensures the testes descend correctly into the scrotum is called testicular descent. Testicular descent usually occurs in two stages. In the first stage, INSL3, a hormone that helps the testis remain in the scrotum, comes into play. In the second stage, the release of CGRP's, a peptide that helps the testis move toward the scrotum, is stimulated by the testosterone hormone. The interaction of testosterone and CGRP's is important in the descent of the testes into the scrotum.

If the testicular descent process is not completed as it should be, the undescended testis problem occurs. Mutations or changes in genes can disrupt the testicular descent process and cause the testis to remain in the abdomen without being able to descend into the scrotum. However, some scientific studies show that gene mutations rarely cause undescended testes. At the same time, it is believed that environmental factors play a role in the occurrence of the undescended testis problem. Factors such as environmental influences disrupting the endocrine system, that is, hormonal disorders, and chromosomal anomalies may cause undescended testes.

According to some scientific studies, birth weight is one of the most important causes of undescended testes. The fact that undescended testis problems are encountered more often in premature babies than in babies born at full term shows the effect of birth weight on the testicular descent process. Although cryptorchidism is a common health problem in babies born at full term, the source of the problem often cannot be precisely identified in those babies. In addition, the risk of cryptorchidism may be higher in those with a family history of undescended testis. In light of this information, the main causes of undescended testis can be listed as follows:

Premature birth (birth occurring before the testes have had sufficient time to descend),

Low birth weight,

Exposure to chemicals that affect the endocrine system,

Mother being obese,

Mother having diabetes,

Exposure to pesticides,

Alcohol consumption during pregnancy (5 glasses or more of alcoholic beverages per week may increase the risk 3-fold),

Mother smoking before and during pregnancy,

Family history of undescended testis,

Use of cosmetic products,

Mother taking ibuprofen-containing medications during pregnancy,

Preeclampsia (pregnancy poisoning),

Congenital anomalies such as Down syndrome and Prader-Willi syndrome.

Undescended testes can cause various health problems in later years, especially reproductive problems. Early diagnosis and treatment can help prevent complications that may arise in later years. Therefore, for your child’s health, do not neglect to make an appointment with a specialist doctor and to have regular health check-ups.

How Is Undescended Testis Diagnosed? What Are the Diagnostic Methods?

Undescended testis is usually easily noticed by healthcare professionals during routine physical examinations. During the examination, a specialist doctor can detect an undescended testis by carefully examining the scrotum, the undescended testis, the groin area, the pubic tubercle, and the inguinal canal. However, in about 30% of cases, the undescended testis may not be detected by physical examination. In cases where the undescended testis cannot be detected visually or by hand, imaging techniques such as ultrasound, CT, or MRI may be used. Early diagnosis is important in the treatment of undescended testis. If you suspect your child has an undescended testis problem, do not delay making an appointment with a specialist doctor.

How Is Undescended Testis Surgery Performed?

The goal of undescended testis treatment is to move the testis to its correct position in the scrotum. Surgical methods are mainly used in treating undescended testis. In addition to surgical techniques, treatment options such as hormone therapy and testicular prosthesis use may also be preferred in some cases. If cryptorchidism is not treated early, it may cause more serious health problems in later years. Therefore, surgical treatment is generally recommended before the baby reaches 18 months of age. For parents, it can be worrying for their baby to undergo even a minor surgical procedure. After surgical treatment performed by specialist physicians in a sterile environment, the testis can be placed in its correct position in the majority of cases.

So, how is undescended testis surgery, also called orchiopexy, performed? Before orchiopexy, the specialist doctor may perform some tests to assess the child’s general health. Before surgery, the doctor informs the parents how long the child should fast and go without water. Also, to reduce the risk of infection, it may be helpful for parents to clean the child’s groin area before surgery. The surgery is performed under general anesthesia. Some healthcare institutions use less medication during anesthesia to minimize risk. If parents have concerns, they can direct their questions about this to the specialists.

During surgery, the specialist surgeon reaches the testis by making a small incision in the child’s groin. Then they check whether the testis is healthy. In cases where the testis is unhealthy, the doctor may remove the testis with the parents’ approval and place a testicular prosthesis in its place. If there is no health problem with the testis, it is placed inside the scrotum with the help of dissolvable stitches, using a grasping instrument.

If the specialist doctor deems it appropriate, the child may go home approximately 2 hours after the operation. During the period the doctor recommends after surgery, using pain-relieving medications can help the child feel comfortable. In addition, the doctor may prescribe some medications to reduce the risk of infection at the surgical site.

After surgery, parents should also take care of the child at home. Washing hands with soap and water before touching the surgical area can help prevent infection. After surgery, it is recommended that the child stay away from activities such as jumping, running, and somersaults for a while.

Frequently Asked Questions

Undescended testis is one of the most common congenital anomalies in male children. Early diagnosis and treatment may make it possible to prevent complications that could arise in later years. Some of the frequently asked questions about undescended testes are detailed below. Like other surgeries, undescended testis surgery carries some risks. However, the majority of operations performed by specialist physicians are successful. Given these risks, it is recommended that the operation be performed in healthcare institutions that have a neonatal intensive care unit and a pediatric intensive care unit. Following successful surgeries, patients can usually be discharged on the same day. If necessary, in some cases a one-night hospital stay may be required. If the child’s general health condition is suitable, pediatric surgery specialists may perform undescended testis surgery and circumcision in the same session. Along with undescended testes in children, testicular swelling is also a common problem. Testicular swelling usually occurs when the connection between the groin and scrotum does not close, causing fluid from the abdominal cavity to leak into the scrotum. Hydrocele, commonly known as “water hernia,” may resolve on its own in some cases. In cases where it does not resolve on its own, treatment of the swollen testis with surgical methods is possible. If there is a problem with one of the testes and it does not resolve on its own, surgery performed by specialist physicians in a full-service hospital may be necessary. Undescended testis is a common congenital anomaly. If you think your child has an undescended testis problem, do not delay making an appointment with a specialist doctor and having check-ups.