Pediatric Undescended Testes

Undescended testes means one or both of the male testes have not passed down (descended) into the scrotal sac. This is a condition seen in some newborn baby boys. Most cases involve only one teste. About one in ten cases affect both testes.

Undescended testes are more often seen in babies who are born early (preterm or premature babies). This is because the testes don’t pass down from the belly into the scrotal sac until month 7 of a baby’s growth in the uterus. Other causes may include hormone problems or spina bifida.

It may be caused by a reflex that causes a testicle to move up and down from the scrotum back into the groin (retractile testes). In some cases, the testes are missing. In rare cases, a boy who has inguinal hernia repair may develop undescended testes.

This condition occurs in about 3 in 100 to 1 in 20 male babies. A baby is more at risk if he:

• Is born before 37 weeks of pregnancy (preterm)
• Is small for gestational age
• Is low birth weight
• Has a family member with the condition

Symptoms can be a bit different in each child. The most common sign is when a healthcare provider can’t feel the testes during an exam. Most children don't have symptoms when they have an undescended testicle.

The healthcare provider will ask about your child’s symptoms and health history. He or she may also ask about your family’s health history. Your child's provider will examine your child's scrotum for testes at every well-child check. In some cases, imaging tests such as ultrasound or MRI are needed to find the testicles within the pelvis. 

Treatment will depend on your child’s symptoms, age and general health. It will also depend on how severe the condition is. In many cases, the testes descend on their own into the scrotum by age 3 months. In most cases, the testes pass down by age 6 months without any treatment.

In other cases, treatment may be needed. This may include:

• Surgery. The undescended testicle may be moved into the scrotal sac with surgery. This surgery is called orchiopexy. It’s often done between ages 6 and 18 months. It works for most children.
• Hormone therapy. Certain hormones may trigger the body to make testosterone. This helps the testes descend into the scrotal sac. This treatment is only used in some cases. Talk with your child’s healthcare providers about the risks, benefits and possible side effects of all medicines.

Talk with your child’s healthcare provider about what kind of treatment is advised for your child.

If testes don’t descend, this can cause problems such as:

• Infertility. This is most common when both testes don’t descend.
• Risk for testicular cancer. This risk increases greatly by age 30 or 40. Men with undescended tests will need to do monthly testicular self-exams.
• Inguinal hernia. This is a weakened area in the lower belly wall or inguinal canal where intestines may push through.
• Testicular torsion. This is a painful twisting of the testes that can decrease blood supply to the testes.
• Emotional stress. An empty scrotum can cause emotional upset to boys and men.

Call the healthcare provider if your baby has no sign of testes in his scrotal sac.