Undescended Testicles: Early Treatment, Fast Recovery

Undescended testicles, or cryptorchidism, is a condition where the testicles are not located in the scrotum as they should be. Normally, during fetal development, the testicles are located in the lower abdomen before gradually moving down from the back of the abdomen, through the groin, and into the scrotum during the third trimester of pregnancy. An interruption of this movement can result in undescended testicles. Undescended testicles can be characterized in four types:

1.1 Characteristics of undescended testicles

• Undescended testicles
  The testicles may not fully descend into the scrotum and may remain in the groin or lower abdomen area.
• Ectopic testicles
  The testicles may move outside the correct path, potentially ending up in the thigh, suprapubic area or contralateral scrotal area.
• Retractile testicles
  This condition occurs when the testicles are positioned normally but they can then move upward on some days and may return to the scrotum on their own.
• Anorchia
  This is a condition where no testicles are present due to developmental abnormalities during fetal development, and this condition can occur on one or both sides.

Currently, there is no definitive conclusion on the exact causes of undescended testicles. However, the following factors may increase the likelihood of developing this condition:

• The child has a congenital abdominal wall defect or weakness, leading to low abdominal pressure that is not able to push the testicles down into the scrotum.
• Hormonal imbalances in the mother during pregnancy.
• Weak connective tissue around the scrotum.
• Genetic disorders and abnormalities related to the reproductive system, such as Down syndrome or ambiguous genitalia.

If there are no complications, undescended testicles will not present any obvious symptoms, as the child will not experience pain or notice any abnormalities, except for the inability to palpate the testicles in the scrotum. However, if complications occur, such as undescended testicles accompanied by a hernia or testicular torsion, it can lead to a sudden groin mass with severe pain.

Undescended testicles can lead to other abnormalities, such as:

• Infertility
  Since the testicles are responsible for sperm production, when they are not in the proper position and environment, sperm production and growth become abnormal, which can result in infertility.
• Testicular cancer
  Due to the improper environment, the growth of cells within the testicles may become abnormal, potentially developing into cancerous cells.
• Hernia
  During the process of forming the scrotum in the fetus, part of the abdominal lining is pulled down as a canal to guide the testicles into the scrotum. Normally, when the testicles are in place, this canal closes. However, if the testicles remain undescended, the canal does not close, which can lead to a hernia as intestines can descend into the area.
• Testicular torsion
  When testicles remain undescended they are unstable, making them more likely to move. This increases the chance of the testicular cord twisting, resulting in severe pain. If not treated promptly, the testicles may lose their blood supply, leading to permanent damage and possibly requiring removal of the testicles.

In newborns, the chance of having undescended testicles is about 2-5%. In most of these cases, the testicles will naturally descend on their own within the first 6 months. Only about 1-2% of infants will experience undescended testicles that do not resolve on their own.

Additionally, undescended testicles can occur in older children, even if they did not have this condition at birth. This may result from factors such as reduced elasticity of the blood vessels supplying the testicles or weak connective tissue.

Undescended testicles is a condition that often occurs during the final trimester of pregnancy, so it can be detected through ultrasound between the 29th and 42nd weeks of gestation. After birth, the condition can be diagnosed through observation or palpation. In cases of undescended testicles, the testicles may be visible as a bulge in the groin, or the scrotum may appear flat. The two testicles may also show clear size differences.

If the scrotum is flat and the testicles cannot be palpated, ultrasound is required to locate the testicles and assess their growth or atrophy. If ultrasound fails to detect the location of the testicles, the doctor may consider an MRI, which provides more detailed results.

Treatment for undescended testicles is typically surgical, as having the testicles in an improper environment may lead to various complications. There are two types of surgery that may be performed for the treatment of undescended testicles, as follows:

7.1. Open Surgery
This traditional form of surgery is suitable when the testicles are located in the groin area, are palpable, and can easily be moved into the scrotum. After surgery, there will be a 2-3 cm scar in the groin area and a small scar in the scrotum, no larger than 1 cm.

7.2. Laparoscopic Surgery
Laparoscopic surgery is suitable when the testicles are located higher up or in the abdomen, making it difficult to move the testicles into the scrotum, or when the exact position of the testicles is unclear. If the testicles cannot be seen or palpated externally, the doctor will opt for laparoscopic surgery.

Both types of surgery usually require a recovery time of around 2 weeks, after which the surgical scarring will improve. During this recovery period, the child will not be able to travel far, so parents should plan ahead before the surgery.

Surgery is recommended for children from the age of 6 months to 1 year, because in the first 6 months there is still a chance that the testicles will naturally descend into the scrotum. Surgery in very young infants also carries a higher risk due to the small size of the organs, meaning there is a possibility of damaging the blood vessels supplying the testicles, leading to testicular atrophy. Additionally, surgery should be performed before the child reaches 1 year of age because, beyond this age, there is a higher risk of permanent testicular atrophy, which could affect future sperm production.

If the child experiences complications, such as a hernia or testicular torsion, the doctor will recommend surgery as soon as possible to prevent further complications that could lead to serious health risks.

Even after surgery to treat undescended testicles, there is still a chance of recurrence, which often occurs due to strain or the stitches coming undone. Therefore, doctors usually recommend that parents monitor the child closely and avoid allowing them to run, play, or exert themselves too much during the first 1-2 months after surgery. 

In addition, doctors will schedule follow-up appointments at 1 month and 3 months after surgery to check the position and condition of the testicles, ensuring they are in the correct position and growing normally. After that, parents should take their child for an annual check-up or conduct self-checks periodically. Even if the undescended testicles have been successfully treated, there remains a risk of testicular cancer, so if parents notice any abnormalities in the testicles, timely treatment should be sought.

Undescended testicles can occur from birth to adolescence, so parents should always monitor their child to see if they have the condition. As children grow older and become more aware, they should be taught to regularly check themselves. If the condition is detected early or if any abnormalities arise, prompt consultation and treatment can be sought.

The pediatric surgeons at the Newborn and Pediatric Surgery Center, Samitivej International Children's Hospital, Bangkok, Thailand are specialists who are certified by the Royal College of Surgeons of Thailand (RCS). All our pediatric surgeons have also undergone extensive training and have more than 10 years of experience. Additionally, they have expertise in laparoscopic surgery specifically designed for children, enabling them to offer pediatric minimally invasive surgery using laparoscopic techniques, where the surgical instruments have small diameters ranging from 2, 3, to 5 mm, depending on the needs of the patient, from newborns onwards. With the use of small laparoscopic cameras, our pediatric surgeons can clearly visualize deep pathologies and immediately remove them with precision using specialized small tools. This method results in smaller incisions (2-5 mm), less tissue damage or bruising, and faster recovery.
Any parent concerned about their child can schedule an appointment for an initial consultation with a doctor online.