From the Guidelines
Male testes should descend into the scrotum by 6 months of age, corrected for gestational age, as spontaneous descent is unlikely after this point 1.
Importance of Testicular Descent
The descent of testes into the scrotum is crucial for proper sperm development and fertility later in life, as the cooler temperature of the scrotum is necessary for these processes.
- Undescended testes have a higher risk of developing testicular cancer and may be more susceptible to torsion or trauma.
- The prevalence of cryptorchidism, a condition where the testes do not descend, is higher in premature boys, affecting about 3% of full-term and up to 30% of premature male infants 1.
Diagnosis and Referral
Primary care providers should palpate testes for quality and position at each recommended well-child visit to detect any issues with testicular descent 1.
- Infants with a history of cryptorchidism who do not have spontaneous testicular descent by six months (corrected for gestational age) should be referred to an appropriate surgical specialist for timely evaluation 1.
- Boys with the possibility of newly diagnosed (acquired) cryptorchidism after six months (corrected for gestational age) should also be referred to a surgical specialist 1.
Treatment
Treatment typically involves surgical correction (orchiopexy) if spontaneous descent does not occur, usually performed between 6-18 months of age to minimize risks to future fertility and testicular health 1.
- Successful scrotal repositioning of the testis may reduce but does not prevent the potential long-term issues of infertility and testis cancer, making appropriate counseling and follow-up essential 1.
From the Research
Testicular Descent
- Testicular descent is a complex process that occurs in two stages: the transabdominal phase (8-15 weeks) and the inguinoscrotal phase (25-35 weeks) 2
- The inguinoscrotal phase requires the migration of the gubernaculum from the groin to the scrotum, guided by the genito-femoral nerve releasing calcitonin gene-related peptide under the influence of androgen 2
Age of Testicular Descent
- Typically, testicular descent is complete by the time a male is born or shortly after birth 3
- Studies have shown that all fetuses with more than 30 weeks postconception (WPC) had testes located in the scrotum 3
- In cases where testicular descent does not occur, orchidopexy is currently recommended at 6-12 months of age to permit optimal tubular development and sperm function 2
Undescended Testes
- Congenital cryptorchidism is caused by the failure of gubernacular migration to the scrotum, affecting 1%-2% of boys 2
- Acquired cryptorchidism, secondary to the failure of spermatic cord elongation with growth, affects another 1%-2% of boys and typically comes to operation at 5-10 years of age 2
- Hormonal therapy has not been proven to be effective in treating undescended testes, presumably due to the complex anatomical mechanism of testicular descent 4, 2