What Is Undescended Testis?
Undescended testis is a condition in which one or both testicles have not descended into the scrotum by the time of birth. During development in the womb, the testicles move from inside the abdomen down into the scrotum; when that descent isn't complete, a testis can remain in the groin or inside the abdomen. It's more common in babies born prematurely.
Why Does It Matter?
The scrotum provides the cooler environment the testis needs to function properly. A testis left in the wrong position for a prolonged period can matter for future fertility and testicular health. That's why timely evaluation and treatment of undescended testis is important.
Does It Descend on Its Own?
Spontaneous descent is possible during a baby's first months. However, after roughly 6 months of age (corrected age for premature babies), the likelihood of spontaneous descent drops significantly. That's why, if a testis is still undescended past 6 months, treatment is planned rather than continuing to wait.
Signs
The most obvious sign is that a testis can't be felt on one or both sides of the scrotum. There's usually no pain or other complaint; it's most often noticed during routine well-baby exams. A "retractile testis" — one that moves up and down at times — is different and may not require treatment; the physician makes this distinction.
Diagnosis
Diagnosis is made by physical exam. If the testis can't be felt, the physician may recommend further evaluation. Since imaging doesn't always give a definitive answer, surgical evaluation (laparoscopy) is sometimes needed to confirm the testis's location.
Treatment and Surgical Timing
Treatment is surgical and is called orchiopexy: the testis is brought down into the scrotum and fixed in place. Current guidelines recommend that, in suitable cases, surgery generally be performed between 6 and 12 months of age, and no later than 18 months. Earlier surgery is considered more advantageous for supporting testicular development than delayed surgery. The procedure is most often done through the groin; a laparoscopic approach may be preferred if the testis is inside the abdomen.
Recovery
Orchiopexy is typically an outpatient or short-stay procedure. Children generally recover quickly. Follow-up of the testis's position and development in the scrotum is recommended afterward.
Frequently Asked Questions
Is it a problem if only one testis hasn't descended?
Evaluation and treatment are recommended even if only one side is affected.
Can we postpone the surgery?
Early treatment is preferred; delaying it is not recommended for the sake of testicular health.
Will this affect having children later in life?
Timely treatment helps preserve reproductive potential; the details are assessed on a case-by-case basis.