Undescended Testicles in Newborns. Cryptorchidism: Symptoms and Treatment

Undescended testicles in newborns 

Normally, the testes form in utero and then gradually drop into the scrotum, which is the small pouch of skin behind the penis. In some cases, this does not occur before birth, causing cryptorchidism. This condition is more likely to occur in babies who are small for their gestational age, born prematurely, diagnosed with congenital malformation syndromes (Down syndrome, Preder-Willi syndrome, Noonan syndrome), have a family history of genital conditions, or were born to a mother who smoked or drank alcohol during pregnancy. 

Undescended testes are usually discovered during a baby's first physical exam shortly after birth. Part of this physical exam is for the physician to feel the scrotum to check for both testicles. If the testicle(s) cannot be felt, the assumption is that this is due to cryptorchidism.

Frequently, undescended testicles are located in the inguinal canal (just above the scrotum) but are not low enough to feel. Less often, the undescended testicle is in the abdomen or absent entirely.

Bilateral undescended testicles

In less than 10 percent of all cases of cryptorchidism, both testes fail to drop into place, leading to bilateral undescended testicles.

Undescended testicles in babies: Symptoms

The main sign of an undescended testicle is not seeing or feeling it in the scrotum of a newborn boy.

Causes of undescended testicles

The precise cause of an undescended testicle is unknown; however, a combination of genetics, maternal health, and other environmental factors can contribute to this medical condition. Premature birth is the leading cause of undescended testicles. The following are some additional factors that can influence the development of cryptorchidism:

• Small for gestational age/low birth weight
• Chemicals called endocrine disruptors may interfere with normal fetal hormone balance
• Family history of genital disorders
• Congenital malformation syndromes (Down syndrome, Preder-Willi syndrome, Noonan syndrome)
• Alcohol and tobacco use by the mother during pregnancy
• Exposure to some pesticides (mother or father)
• Maternal morbidity (obesity, diabetes, preeclampsia)

How is cryptorchidism diagnosed?

A physical examination can diagnose undescended testicles in newborn babies and should be performed at all well-baby checkups, starting at birth. When undescended testes are detected, they can be either palpable (felt by touch) or non-palpable. This diagnosis requires an examination by a medical professional and a cooperative newborn. 

The health care provider will need to hold the baby's scrotum in one hand and feel the scrotum and inguinal canal with the other hand. The baby will lay on their back with their knees bent and hips flared outward, like frog legs. 

Babies born with a suspected undescended testicle may need to undergo a diagnostic laparoscopic evaluation. This procedure is performed under general anesthesia. The surgeon will make a small incision, then place a tiny camera through a tube. This allows the surgeon to visualize the area and determine if treatment is necessary. If necessary, surgical treatment can occur during the same administration of anesthesia.

What is the treatment for undescended testicles?

During an examination of the newborn's testicles, the medical professional can identify whether or not the testes can be manipulated into the scrotum with gentle traction (also known as "milking"). If the testicle can be brought down into the scrotal sac (even temporarily), this is known as a retractile testis, and a pediatrician can safely monitor the baby without surgical intervention. 

If the physician cannot encourage the testicle into place, this is an actual undescended testicle and will require treatment of hormones (hCG) or surgery (orchidopexy). The only hormone labeled for the treatment of cryptorchidism in the United States is hCG. This hormone is administered through intramuscular injections. This isn't the typical way to treat cryptorchidism, though. It can have side effects and is usually less effective than surgery.

If surgery is required, it should be done before the baby is 18 months old.

Surgery for undescended testicles

Surgical correction is often suggested soon after a diagnosis of undescended testicles. This surgery is called orchiopexy and is usually performed when babies are between 6 and 18 months old because this helps maximize fertility potential and adequate hormone production.

Most babies diagnosed with suspected undescended testicles are referred by their pediatrician to a specialist once they turn three months old. Before three months, the testes can spontaneously descend into the scrotum with no additional surgical intervention required. These babies can have routine follow-ups by their pediatrician with regular physical exams that include testicular checks.

Cryptorchidism remains the most common urogenital disorder affecting newborn boys. The most serious problems that can come from undescended testicles are infertility and an increased risk of undetected hernias and testicular cancer. Orchiopexy remains the treatment of choice and has a significantly high success rate, as it can reduce the risk of infertility and testicular cancer.