Undescended testicles

An undescended testicle (cryptorchidism) means one or both testicles have not moved down into the scrotum before birth. The testicles normally descend during the last months of pregnancy. If they don't, treatment is usually recommended in the first year or two of life to reduce the risk of long-term problems.

About 3-4% of full-term baby boys have an undescended testicle at birth; it's more common in preterm babies. Most descend on their own in the first 3-6 months; after that, surgery is usually needed.

Why it matters

If not treated, undescended testicles carry a higher long-term risk of:

• Fertility problems (lower sperm production)
• Testicular cancer — the risk is higher but is significantly reduced by early surgical correction
• Inguinal hernia
• Testicular torsion (twisting of the testicle)

Diagnosis

Found during the newborn examination or at later paediatric check-ups — the scrotum feels empty on one or both sides. Some testicles can be felt higher in the groin ("palpable"); others are not felt at all and need imaging or surgery to locate.

Treatment

• Watchful waiting for 3-6 months — many spontaneously descend
• Surgery (orchidopexy) — the standard treatment; the testicle is brought down into the scrotum and fixed in place. Best done between 6-18 months of age.
• Adolescent or adult undescended testicles sometimes need removal rather than repositioning, because of the cancer risk and reduced function at that stage

Outcomes are excellent when surgery is done in the first 1-2 years. Lifelong self-examination of the testicles is advised — any man with a history of undescended testicle should know how to check for lumps.

If you notice an absent testicle in your child at any age, see a paediatrician. Don't delay — early intervention gives the best outcomes.