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The conditions where the testicles fail to descend into the scrotum is called as cryptorchidism. One or both the testicles can be affected by this condition.

Why do testicles fail to descend?

Under normal conditions, testicles form inside the womb and descend into the scrotum a little before both. In some cases, however, due to unknown reasons or in cases of premature birth, the testicles do not descend into the scrotum at the time of birth.

In about 50% of these babies, the testicles will descend into the scrotum by about six months of age. If the testicles have not been descended by the age of 1 year, an examination by the doctor is necessary.

Diagnosis of undescended testicles

A diagnosis of undescended testicles is reached by a physical examination done by the doctor at the time of birth or afterward. It is important to distinguish between undescended testicles, which is a serious condition requiring treatment, and retractile testicles, where testes may retract back into the abdomen for a short while. The latter is a normal condition that does not require any medical intervention.

Impact of undescended testicles on health and fertility

The testicles are where the sperm is formed in the body. By remaining undescended in the abdomen, the testicles are at a higher temperature than they ideally should be and this impacts their ability to make sperm leading to a much higher chance of infertility.

Undescended testicles in adults are also associated with a much higher rate of turning cancerous and should thus be treated with urgency.

Inguinal hernias can result from undescended testicles and also increase the chance of injury occurring to them.

Treatment

A surgical procedure called as orchiopexy needs to be performed to physically bring down the testicles into the scrotum. The surgical procedure is considered relatively straightforward and most cases do not require an overnight admission into the hospital.

The recovery after the surgery takes about a week.

The long-term prognosis for males who had one undescended testicle is much better than those that had two. Current opinion states that males with one undescended testicle do not have any effect on their fertility while those with two will have a significantly higher chance of being infertile.

The case of undescended testicles in males is much more challenging. Even the location of the testes in the abdomen can be a difficult job often requiring the use of CT scans. The risk of malignancy in adults is so high that it is recommended undescended testicles be removed through surgery.

Some doctors even advocate the removal of a single undescended testis if it has remained like that till adulthood.

Post-surgical treatment with testosterone shots will be required to help maintain the physical male characteristics in some patients but that is determined on a case to case basis.

In a small percentage of people, the testes do not form at all and thus are not found on CT scans or surgical exploration. This is could be the result of a genetic abnormality or injury to the fetus during the pregnancy.  

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