occurs when one or both testicles fail to move into the scrotum
Cryptorchidism; Empty scrotum - undescended testes; Scrotum - empty (undescended testes); Monorchism; Vanished testes - undescended; Retractile testes
Causes, incidence, and risk factors
Most of the time, a boy’s testicles descend by the time he is 9 months old. Undescended testicles are fairly common in infants who are born early. The problem occurs less often in full-term infants.
Some babies have a condition called retractile testes and the health care provider may not be able find the testicles. In this case, the testicle is normal but is pulled back out of the scrotum by a muscle reflex. This is able to occur because the testicles are still small before puberty. The testicles will descend normally at puberty and surgery is not needed.
Testicles that do not naturally descend into the scrotum are considered abnormal. An undescended testicle is more likely to develop cancer, even if it is brought into the scrotum with surgery. Cancer is also more likely in the other testicle.
Bringing the testicle into the scrotum can improve sperm production and increase the chances of good fertility. It also allows the health care provider to do an exam for the early detection of cancer.
In other cases, no testicle may be found, even during surgery. This may be due to a problem that occurred while the baby was still developing before birth.
Most of the time there are no symptoms other than the absence of the testicle in the scrotum. (This is called an empty scrotum.)
Signs and tests
An exam by the health care provider confirms that one or both of the testicles are not in the scrotum.
The health care provider may or may not be able to feel the undescended testicle in the abdominal wall above the scrotum.
Imaging tests, such as an ultrasound or CT scan, may be done.
In most cases, the testicle will descend without treatment during the child’s first year. If this does not occur, treatment may include:
- Hormone injections (B-HCG or testosterone) to try to bring the testicle into the scrotum
- Surgery (orchiopexy
) to bring the testicle into the scrotum. This is the main treatment.
Having surgery early may prevent damage to the testicles that can cause infertility. An undescended testicle that is found later in life may need to be removed. This is because the testicle is not likely to function well and could pose a risk for cancer.
The problem goes away without treatment most of the time. Medicine or surgery to correct the condition is successful in most cases.
In about 5% of patients with undescended testicles, the testicles cannot be found at the time of surgery. This is called a vanished or absent testis.
Calling your health care provider
Call your child's health care provider if he appears to have an undescended testicle.
Barthold JS. Abnormalities of the testes and scrotum and their surgical management. In: Wein AJ, ed. Campbell-Walsh Urology.10th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 132.
Elder JS. Disorders and anomalies of the scrotal contents. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 539.
Wampler SM, Llanes M. Common scrotal and testicular problems. Prim Care. 2010; 37:613-626.
Scott Miller, MD, Urologist in private practice in Atlanta, Georgia. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.