Undescended Testes: When and How to Treat

The term undescended testis refers to a testicle that is not within the scrotum. Sometimes the term cryptorchidism is also used to refer to them.

They must be distinguished from the so-called ascending testicles, which are those that have great laxity and can ascend to the inguinal canal by the effect of the cremasteric reflex, but most of the time the testicle remains in the scrotum. This is diagnosed by physical examination of the patient.

What are the causes? Are both testicles affected?

It occurs because during their formation the testicles stop their normal descent from the renal fossa to the scrotum at some point, therefore, they can be located from the intra-abdominal cavity, the inguinal canal (groin) or near the scrotum.

The descent is a consequence of the interaction of neurotransmitters and mechanical and hormonal factors. Any alteration in these factors can affect the normal descent of the testicle and, therefore, place it at some point in its trajectory towards the scrotal sac.

One or both testicles may be affected.

How are undescended testicles diagnosed?

The diagnosis is made by physical examination. Examination by a specialist in pediatric urology who is an expert in distinguishing an undescended testicle from an ascending or retractile testicle is necessary.

The undescended testicle will require surgical intervention, while the ascending testicle does not require surgery. It is also important to distinguish whether the undescended testicle is palpable or non-palpable. This will determine the type of surgery to be performed. In non-palpable testicles a laparoscopic evaluation is necessary to locate the testicle and descend it.

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What does the treatment consist of? From what age can it be performed?

It usually takes about 6-8 months for the testicles to complete their descent into the scrotal pouch. Therefore, the patient requires periodic check-ups so that the doctor can assess the probability of descent according to the evolution. If they have not descended into the scrotal sac, surgical intervention will be necessary before 12-18 months to avoid damage to the testicular germ cells.

At this point it is very important to differentiate between palpable and non-palpable undescended testes. When they are outside the scrotum, but palpable, they are operated with open surgery through an incision in the groin. If they are not palpated, laparoscopy must be performed to locate the testicle within the abdominal cavity and descend it into the scrotal sac. Sometimes a two-stage or two-phase surgery may be necessary to successfully place the testicle in the scrotal sac.

Is this pathology exclusive to boys?

No. It is a pathology that is usually diagnosed and treated in the pediatric age. But it can happen that some patients have not been diagnosed during childhood and reach adulthood with an undescended testicle. Sometimes, in adults, removal of the testicle is necessary because of the likelihood of malignancy of the testicle.