ConditionChildren's health
Cryptorchidism (Undescended Testicle)
Cryptorchidism, or an undescended testicle, means one or both testicles have not moved down into the scrotum before birth. It is one of the most common birth differences in boys, affecting about 3 percent of full-term and up to 30 percent of premature baby boys. Many testicles descend on their own by 6 months of age. If not, surgery called orchiopexy, ideally between 6 and 18 months, moves the testicle into the scrotum to protect fertility and make it easier to check for cancer later.
Also called: Undescended testicle, undescended testis, maldescended testis
At a glance
- What it is
- A testicle that is not in the scrotum, sitting in the groin or abdomen.
- How common
- About 3 percent of full-term boys; far more in premature babies.
- Natural course
- Many descend by 3 to 6 months; after that, descent is unlikely.
- Treatment
- Orchiopexy surgery, ideally before 18 months.
- Why it matters
- Reduces risks to fertility, makes cancer checks easier and lowers torsion risk.
When to get help
Call 911 or go to the ER
- Sudden severe groin, belly or scrotal pain in a boy with an undescended testicle (possible torsion)
- A painful, tender lump in the groin that cannot be pushed back, with vomiting (possible trapped hernia)
See a doctor within a day or two
- Neither testicle can be felt in a newborn, especially with other genital differences
Book a routine appointment
- One or both testicles not in the scrotum at newborn or well-baby checks
- A testicle that is still not down by 6 months of age
- A testicle that used to be in the scrotum but now stays in the groin (ascending testis)
What happens normally
Testicles develop inside the abdomen near the kidneys. In the last months of pregnancy they travel down through the groin canal (inguinal canal) into the scrotum, guided by hormones and a cord-like structure called the gubernaculum. Cryptorchidism happens when this descent stops partway.
Types
| Type | Description |
|---|---|
| Palpable undescended testis | Can be felt in the groin, about 80 percent of cases |
| Non-palpable testis | Cannot be felt; may be in the abdomen, absent, or very small |
| Ectopic testis | Moved off the normal path, for example to the thigh or perineum |
| Retractile testis | Moves up and down with a strong reflex muscle, but can be brought fully into the scrotum and stays there briefly. Not true cryptorchidism, but needs yearly checks |
| Acquired (ascending) testis | Was in the scrotum earlier but later moves up, often around school age |
Causes and risk factors
- premature birth and low birth weight (the biggest risk factor)
- family history of undescended testicles
- maternal smoking, diabetes or obesity in pregnancy
- hormone problems and some genetic conditions
- other genital differences such as hypospadias
When both testicles cannot be felt, or there are other genital differences, doctors check for conditions affecting sex development.
Symptoms
Usually there are no symptoms other than an empty or underdeveloped scrotum on one or both sides. An inguinal hernia often accompanies it, appearing as a groin bulge.
Diagnosis
Diagnosis is by physical examination, usually at newborn and well-child visits, with the child relaxed and warm. Ultrasound is not routinely recommended, because it rarely changes management. For non-palpable testicles, diagnostic laparoscopy is the standard way to find an abdominal testicle. Hormone and genetic tests are used when both testicles are non-palpable.
Treatment
Watchful waiting
If the testicle has not descended by 6 months (corrected for prematurity), it is unlikely to do so. Referral to a pediatric urologist or surgeon is recommended at that point.
Orchiopexy
The AUA recommends surgery ideally by 18 months of age. The surgeon frees the testicle and cord and fixes the testicle in a pocket in the scrotum. It is usually a day procedure through small groin and scrotal incisions. For abdominal testicles, laparoscopic surgery is used, sometimes in two stages. A testicle that is very small or not viable may be removed.
Success rates are high, especially for testicles in the groin.
Hormone treatment
Hormone injections are not recommended to bring testicles down, because success rates are low.
Why treatment matters
- Fertility: the higher temperature in the body can harm sperm-producing cells. Early surgery improves fertility potential. Men with one undescended testicle usually have near-normal fertility; fertility is more affected when both are involved.
- Testicular cancer: risk is higher than average. Orchiopexy before puberty lowers the risk and puts the testicle where it can be examined.
- Testicular torsion: an undescended testicle is more prone to twisting.
- Hernia and body image.
Outlook
Most boys who have orchiopexy grow up with normal function. Teach boys to perform testicular self-examination from puberty, and attend follow-up checks to confirm the testicle stays in place and grows.
Frequently asked questions
Can an undescended testicle come down on its own?
Yes, often in the first few months of life. Most testicles that will descend do so by about 6 months of age. After that, spontaneous descent is unlikely, and surgery is recommended.
What is the best age for orchiopexy?
Guidelines recommend surgery between 6 and 18 months of age. Earlier surgery appears to better protect future fertility. Boys diagnosed later, including with acquired undescended testicles, should have surgery soon after diagnosis.
Does an undescended testicle cause infertility?
It can reduce fertility, especially when both testicles are affected or surgery is delayed. Men with one corrected undescended testicle usually father children normally. Early orchiopexy gives the best chance of preserving fertility.
What is the difference between a retractile and an undescended testicle?
A retractile testicle moves up into the groin with a muscle reflex, but can be gently brought into the scrotum and stays there for a while. An undescended testicle cannot be brought into the scrotum. Retractile testicles usually need monitoring rather than surgery.
Sources
This guide was written from current patient and clinical guidance, including:
- American Urological Association: Evaluation and treatment of cryptorchidism guideline
- American Academy of Pediatrics (HealthyChildren.org): Undescended testicles
- MedlinePlus: Undescended testicle
- NHS: Undescended testicles
- European Association of Urology: Guidelines on paediatric urology