Cryptorchidism or undescended or hidden testicles

What is cryptorchidism?

The failure of the testicles (or “testes”) to descend into the scrotum (the skin sac below the penis) is called “cryptorchidism”. It is also called having hidden or undescended testicles. The condition is generally uncommon but often affects boys born prematurely.

As a male foetus grows, the testicles appear in the abdomen near the kidneys. During the seventh month of development, the testicles start to descend to the groin. They should reach their final position in the scrotum by 6 months after birth.

The testicles make sperm and testosterone, the male sex hormone. An undescended testicle may produce hormones, but the ability to make sperm is disrupted.

At 1 year of age, nearly 1% of all full-term male infants have cryptorchidism. This is the most common birth defect of the sex organs in newborn male infants. Usually, only one testicle is affected, but both testicles are undescended in about 10% of children with cryptorchidism.

Fig. 1: in cryptorchidism, the testicles fail to descend into the scrotum. Illustration shows the percentage of the testicle position in patients with cryptorchidism.
Fig. 1: in cryptorchidism, the testicles fail to descend into the scrotum. Illustration shows the percentage of the testicle position in patients with cryptorchidism.

Recommendations for cryptorchidism

  • Boys with retractile testes do not need medical or surgical treatment but require close follow-up until puberty.
  • Surgery to move the undescended testicle to the scrotum should be done by 1 year of age or 18 months at the latest.
  • For boys with non-palpable testes and no evident disorders of sex development, laparoscopy is the best way to find a testicle in the abdomen. The testicle can be removed or repositioned in the same session.
  • Hormonal therapy is not a standard treatment.
  • For a boy aged 10 years or older with one normal testicle and one testicle in the abdomen, removal of the non-palpable testicle can be considered because of the risk of developing testicular cancer later.
  • Male newborn infants with two non-palpable testicles should be evaluated for possible disorders of sex development.

This information was produced by the EAU Patient Information Working Group, March 2017.

 

  • Dr. M. Innocenzi, Rome (IT)
  • Dr. M. Kubát, Brno (CZ)
  • Dr. A. Prouza, Prague (CZ)