A Baby Boy's Scrotum Should Drop by What Age

Treatment Options for Children With Undescended Testicles

A Review of the Research for Parents and Caregivers

John M. Eisenberg Center for Clinical Decisions and Communications Scientific discipline.

Author Information

Created: August xxx, 2013.

Is This Information Right for Me?

If you lot meet all of the following, this information is for you:

Your child'southward doctor^* has told y'all that your child has an undescended testicle or testicles. This happens when one or both testicles exercise non drop downwards into the scrotum before birth. This condition is called "cryptorchidism" (pronounced crip-TOR-kid-iz-um).
You want to know what researchers have found about handling options for undescended testicles.
Your child has not all the same gone through puberty. The data in this summary is from research on boys before puberty.

What will this summary cover?

This summary will encompass:

What it ways to take undescended testicles
Treatment options for children with undescended testicles
What researchers have institute about how well the treatments work
Possible side effects of the treatments

This summary can assist yous talk with your child's doctor about what treatment might be correct for your child.

Where did the information come up from?

Researchers funded by the Agency for Healthcare Inquiry and Quality (AHRQ), a Federal Government inquiry agency, reviewed 60 studies on treatments for undescended testicles published betwixt 1980 and February 2012. The report was reviewed by clinicians, researchers, experts, and the public. You can read the report at world wide web.effectivehealthcare.ahrq.gov/undescended-testicle.cfm.

Understanding Your Child's Condition

What are undescended testicles?

Testicles are the two small brawl-shaped organs inside the scrotum (the sac of skin below the penis) that brand male person hormones and sperm. An undescended testicle happens when one or both of a kid's testicles do non drop down into the scrotum before birth. This condition is called "cryptorchidism."

When a infant boy develops in his female parent's womb, the testicles form in the infant's belly (belly). Right before birth, the testicles driblet down (descend) into the scrotum.

In some babies, one or both testicles practise not drop downwardly like they should. Undescended testicles may be in the belly or groin area. Information technology is too possible for a baby to be born without one or both testicles. Undescended testicles could be healthy and piece of work normally. Sometimes, notwithstanding, undescended testicles practise non develop correctly and exercise non work like they should.

Doctors exercise not know what causes undescended testicles. But, they are not caused by annihilation the mother did during pregnancy.

In seven out of every 10 babies born with undescended testicles, the undescended testicles will drop down into the correct position before the baby is 6 months old. If your kid's testicles exercise not drop by and so, it is important to talk with your kid'due south doctor about treatment options.

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How common are undescended testicles?

Out of every 100 full-term male babies, iii are born with undescended testicles.
Out of every 100 male babies built-in prematurely (too early), up to 30 are born with undescended testicles.
Out of every 100 boys with undescended testicles, the undescended testicle cannot be found in upwards to 5.

What problems could an undescended testicle crusade?

A testicle that does non drop into the correct place in the scrotum could get damaged. This could lead to infertility (non beingness able to have children) later in life or to other medical issues.

Men who take had undescended testicles (one or both and whether treated or not) may have an increased risk for testicular cancer. It is of import for men and teenage boys who take had this condition to examine their testicles each calendar month to experience for lumps or other signs of tumors or bug.

Agreement Your Options

How are undescended testicles treated?

The goal of treatment is to bring undescended testicles down into the correct place in the scrotum. If your kid'south testicle has not descended by the time your child is six months sometime, you lot should talk with your child's physician about treatment options. The doctor will likely recommend surgery. Rarely, hormonal handling may exist an option.

It is all-time to treat undescended testicles while your child is still very young—betwixt 6 months and 1 year of age.

Surgery

Your child's doctor volition probable suggest surgery (either orchiopexy or FS orchiopexy) to move your child's undescended testicle down into the scrotum.

Orchiopexy: If your kid's undescended testicle is low in the abdomen or in the groin, the testicle can be moved to the scrotum in a surgery chosen an "orchiopexy" (pronounced OR-kee-oh-PEK-come across).
FS Orchiopexy: If your child'southward undescended testicle is loftier in the belly, the blood vessels attached to the testicle might not be long plenty to reach downwardly into the scrotum. In this example, the surgeon will need to practise a different type of surgery. This surgery is called a "Fowler-Stephens" (or FS) orchiopexy. It tin can exist done in two ways:
- 1-step surgery: a single surgery
- Two-step surgery: two separate surgeries done at to the lowest degree half-dozen months apart

Open up Surgery or Laparoscopic Surgery

Orchiopexy and FS orchiopexy tin exist done as either open surgery or laparoscopic (pronounced lah-puh-ruh-SKAHP-ik) surgery (see below for a description of each). If your kid's undescended testicle is in the groin, the surgeon will do open surgery. If the surgeon is unsure of where the testicle is or cannot find it, laparoscopic surgery can be done to see if the testicle is in the belly. If the testicle is establish in the belly, the surgeon may exercise either open or laparoscopic surgery to move it downwards into the scrotum.

Open up surgery: The surgeon makes a cut in your child's abdomen or groin and scrotum to do the surgery.
Laparoscopic surgery: The surgeon uses a tool chosen a laparoscope (pronounced LAH-pruh-skohp) for the surgery. A laparoscope is a thin tube with a tiny photographic camera that the surgeon puts through small cuts in your kid'due south belly along with other small tools to do the surgery. The laparoscope lets the surgeon meet inside your child's body to do the surgery without having to make big cuts.

The type of surgery your child needs depends on the location of the undescended testicle. Your child's doctor can tell you which blazon of surgery your child needs.

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Location of the undescended testicle:	Blazon of surgery:
Groin	Open orchiopexy
Low in the belly	Open or laparoscopic orchiopexy
High in the belly	One-step open or laparoscopic FS orchiopexy or Two-step open up or laparoscopic FS orchiopexy

What take researchers found about how well surgery works to treat undescended testicles?

Researchers found that surgery works well to bring undescended testicles downward into the scrotum. Sometimes though, the testicle can get damaged during surgery, causing it to no longer work.

The chart below shows how successful each type of surgery is. Information technology also shows how often testicles get damaged in each type of surgery.

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Surgery type:	This type of surgery is done when:	This surgery is successful in:	Testicles get damaged during this type of surgery in:
Orchiopexy	The undescended testicle is low in the belly or in the groin and the blood vessels are long plenty to reach into the scrotum	96 of 100 boys	2 of 100 boys
1-pace FS orchiopexy ^†	The undescended testicle is high in the belly and the blood vessels are not long plenty to accomplish into the scrotum	78 of 100 boys	28 of 100 boys^*
Ii-footstep FS orchiopexy ^†		86 of 100 boys	eight of 100 boys^*
Researchers as well found:
Open surgery and laparoscopic surgery appear to piece of work just as well as each other for undescended testicles in the belly, but more inquiry is needed to know for certain.

†: There is non enough research comparing ane-step with two-pace FS orchiopexy to know which might work best.
*: More enquiry is needed to know this for sure.

What are the possible side effects of surgery to treat undescended testicles?

Surgery to treat undescended testicles is by and large safe, and complications are rare. But there are possible side furnishings with any surgery, including:

Bleeding
Infection
Injury to blood vessels
Injury to organs (such as the testicles, the spermatic cords attached to each testicle, the float, or others)
Risks of general anesthesia, such as pneumonia, center attack, or stroke, although these are rare

It is likewise possible for the testicle to go back up into the groin or belly after surgery. If this happens, some other surgery may exist needed to bring the testicle dorsum downward or to remove it.

Volition surgery to treat undescended testicles affect my kid's fertility?

Men who had surgery as a child to treat one undescended testicle usually do not have issues with fertility (the ability to take children). Men who had surgery as a child to care for two undescended testicles are more than likely to have bug with fertility than men who had only one undescended testicle.

Hormonal Treatment

Hormonal treatment is another pick to treat undescended testicles in particular cases, but it is rarely used. If your child's testicle is close to the scrotum, the doctor may suggest hormonal treatment to attempt to get the testicle to drop downwardly. The hormone used is chosen hCG (human chorionic gonadotropin). This hormone comes equally a shot that the doctor gives your child two to four times a week for 4 or more than weeks.

What have researchers found about how well hormonal treatment works?

Researchers found that hormonal treatment with hCG may work slightly better than no hormonal treatment in boys whose testicles are about the scrotum. Just, more research is needed to know for sure if hormonal treatment works. If hormonal handling works, it is however possible for the testicle to get support into the groin or belly. There is non enough research to know how oft this happens.

Note: If hormonal treatment does not work or if your child's testicle is far from the scrotum, the doctor volition likely propose surgery to bring the undescended testicle down into the scrotum.

If your child has a hernia (when part of the intestine or belly fat pokes through an opening in the groin muscles) with his undescended testicle, he may need surgery.

What are the possible side effects of hormonal treatment?

Possible side effects of hCG hormonal treatment for undescended testicles are listed below. Not every kid who is treated with hCG will take side effects. Side effects usually become away when treatment ends. But, researchers practice not know if hormonal handling may cause other problems as an developed such as non being able to take children.

Headache
Irritability
Restlessness
Depression
Tiredness
Swelling in the legs, ankles, and feet
Breast growth
Enlarged penis
Pubic or armpit pilus growth
Erections
Ambitious behavior
Pain where the shot was given

What are the costs of treatments for undescended testicles?

The costs to you for surgery or hormonal treatments depend on your health insurance.

Making a Conclusion

What should I retrieve about when deciding?

There are many things to think about when deciding which treatment might exist best for your kid. You may want to talk with your child's medico about:

Whether surgery or hormonal handling could aid your kid
The possible benefits and side furnishings of the treatment
The costs of the treatment

Ask your dr.

What would happen if my child receives no treatment?
At what age should my child become treatment?
What is the best treatment option for my child?
If my child has surgery, which blazon of surgery would he need?
Would open up or laparoscopic surgery exist better for my child?
What possible side effects should I watch for?
How will nosotros treat any side effects my child has?
How long volition information technology take my child to recover from surgery?
What activities should my child avoid right afterwards surgery?

Sources

The information in this summary comes from the report Evaluation and Treatment of Cryptorchidism, Dec 2012. The report was produced past the Vanderbilt Evidence-Based Practice Middle through funding by the Agency for Healthcare Research and Quality (AHRQ).

For a re-create of the study, or for more data about AHRQ and the Effective Health Care Programme, go to world wide web.effectivehealthcare.ahrq.gov/undescended-testicle.cfm.

Additional data came from the MedlinePlus^® Web site, a service of the National Library of Medicine and the National Institutes of Health. This site is bachelor at www.nlm.nih.gov/medlineplus.

This summary was prepared past the John One thousand. Eisenberg Center for Clinical Decisions and Communications Science at Baylor College of Medicine, Houston, TX. Parents or caregivers of children with undescended testicles reviewed this summary.

*: In this summary, the term "doc" refers to your child's health care professional, including your child's pediatrician, pediatric urologist (a medico who treats children with conditions of the genitals or urinary tract), surgeon, nurse practitioner, or medico assistant.

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Source: https://www.ncbi.nlm.nih.gov/books/NBK164535/