Dear Dr. Theriot,
Our new grandson is a few weeks old. We were surprised to find out that one of his testicles has not come down. The doctor said that he may need to have surgery when he is older. What exactly is this? Is it serious? Does he really need surgery?
In the growing fetus, the testicles (testes) are actually situated within the abdominal cavity. As the fetus approaches full term, the testes migrate down into the scrotum. Undescended testes refers to the situation whereby the testicles have not properly descended in the scrotum.
This occurs in around 3-4% of all full term newborn males. The incidence is about 30% in premature males. By 1 year of age, the incidence is 0.8% which is the same rate seen in adult males. This suggests that the undescended testes that are going to resolve on their own, will have done so by 1 year of age.
Major complications that are a concern regarding undescended testes are infertility, and the risk for malignancy of the testicle. Studies have shown that by 2 years of age, there are obvious tissue changes and differences between the undescended testicle and the normal one when examined under the microscope. The sperm count is noticeably decreased in undescended testes, especially if not treated early.
An interesting finding is that by 8-12 years of age, there are tissue changes and a reduced sperm count even in the normal testicle even though it is properly positioned in the scrotum. This is probably due to the fact that the body produces antibodies "against" the undescended testicle. These antibodies, however, also affect the normal testicle.
The undescended testicle has a much greater chance of developing cancer than a normal testicle (10-20 times more likely), although the overall risk is still somewhat small, around one in a thousand. One of the possible causes for this could be the constant exposure to greater temperatures when not in the scrotum where the temperature remains constant at all times ( in the abdomen for example).
Other possible complications that can occur are an associated hernia, or a twisting or torsion of the blood supply to the undescended testicle. This is a surgical emergency.
Treatment of undescended testes is usually surgical whereby the surgeon literally brings the testicle down into the scrotum and secures it there by tacking or suturing it in place. This can be done as an out patient in most cases. Another possible treatment is a series of hormone injections. This is less successful, especially in young children. Some physicians like to try this first in the hopes of avoiding surgery. But the overall success rate is around 40% in children under 5 years it is only 10-20% successful.
The ultimate treatment choice depends on a number of factors the doctor must weigh. There remain a number of unanswered questions about undescended testicles. There are no hard and fast rules about the treatment and the ideal time to treat. One thing remains certain however, and that is the timely repair of this condition before two years of age. Most physicians will observe a child until they are 1 year old to allow this to correct itself spontaneously. If it has not resolved itself by one year of age, it is not likely to do so. Plans should then be made to ultimately repair this by whichever approach the doctor feels most appropriate.
I realize that you and your family will have many more detailed questions regarding this. Please discuss them in detail with your grandson's doctor.