Undescended Testes

Definition/diagnostic criteria Undescended testes, also known as cryptorchidism, refer to a congenital condition in which one or both testicles fail to descend into the scrotum by the time of birth. It is essential to differentiate between true undescended testes and retractile testes, where the testes can be manipulated into the scrotum but tend to return to a higher position. The diagnostic criteria for undescended testes include a physical examination to confirm the absence of one or both testes in the scrotum at birth or within the first few months of life. This condition can affect a single testis (unilateral) or both testes (bilateral) and may be palpable or non-palpable in the inguinal region.

Epidemiology Undescended testes are relatively common, with a reported incidence of approximately 1-4% in full-term male infants. The prevalence is higher in premature infants, affecting up to 30% of those born prematurely. This condition is more common in males with a low birth weight and is associated with other congenital anomalies, such as inguinal hernias. The prevalence of undescended testes tends to decrease with age, as some testes may descend spontaneously during the first few months of life.

Diagnosis

Clinical features Clinical examination is key in the diagnosis of undescended testes. GPs should perform a thorough physical examination, particularly during routine well-baby checks. Palpation of the scrotum and inguinal canal is essential to identify the presence and location of the testes. A non-palpable testis may indicate an abdominal or absent testis, while a palpable testis may suggest an inguinal or high scrotal location. GPs should also assess for any associated anomalies, such as inguinal hernias.

Management The primary goal is to ensure the testicles are in the scrotum by the age of one year. Treatment options include:

Observation

• In cases of retractile testes, no treatment may be required as the testes may descend naturally. Regular clinical follow-ups are essential to monitor progress.
• If there are suspected bilateral undescended testes at 6–8 weeks of age arrange urgent referral to a paediatrician to be seen within 2 weeks.
• If there is a suspected unilateral undescended testis at 6–8 weeks of age — re-examine the infant at 4–5 months of age. At 4–5 months (corrected for gestational age), if the testis remains undescended, arrange referral to paediatric surgery or urology to be seen by 6 months of age.
• If there is any uncertainty in differentiating between a possible undescended testis and retractile testis, arrange referral for clarification of the diagnosis.
• If both testes are in the scrotum, but one or both are retractile, advise the parents/carers that annual follow up and re-examination is needed until after puberty, as there is a significant risk of ascending testis.

Surgery Surgical intervention, called orchidopexy, is the most common and effective treatment for undescended testes. This procedure involves moving the testis into the scrotum and securing it in place. Orchidopexy is typically performed between 6 to 18 months of age and carries a high success rate.

Follow up Boys and young men with a history of undescended testis should be advised to perform regular testicular self-examination during and after puberty, owing to the increased risk of developing testicular cancer.

Prognosis Early correction of undescended testes is crucial to prevent potential complications, such as infertility, testicular malignancies, and impairment of fertility potential. Orchidopexy is associated with a high success rate in achieving proper testicular descent.