What to do about an undescended testicle

Dear Dr G,

My husband and I have recently started a family, and we are blessed with a dragon baby born in March. When my son, Benjamin, went for his full moon baby check at the clinic, we were shocked to discover that he only has one testicle.

I am somewhat puzzled by this. Throughout the pregnancy, I was very careful with my diet and nutrition. Despite all our efforts, baby Ben was born prematurely, around six weeks before the due date. Although the doctors were initially concerned about his breathing, his strength and overall condition improved with the excellent care in the hospital.

When the doctor examined my baby and noticed he only has one testicle, he didn’t seem surprised as Ben was born prematurely. We were advised to consider corrective surgery before Ben turns two.

As this has come as a shock to us, we hope to put Dr G on the spot for my son’s missing testicle. What exactly happens to an undescended testicle, and how common is it? Do those affected encounter any sexual compromises? How does the hidden testicle affect his ability to father a child in the future? More importantly, can this cause cancer?

In view of the above, should we hunt for the missing testicle?

Regards,

Ballless Benjamin

Undescended testicle (UDT), also known as cryptorchidism, derives from the Greek words “kryptos” (hidden) and “orchis” (testicle). Cryptorchidism is a relatively common congenital abnormality affecting one or both testicles. The condition has a high prevalence of up to 30% among premature infant boys due to incomplete descent.

It is also observed in around 3% of full-term babies. Eighty percent of cryptorchid testes will naturally descend by the first year of the child’s life, making the overall incidence of true cryptorchidism about 1%. An undescended testicle can occur when a child is born with one or both testicles “lost” along the path of descent.

Recent epidemiological data has shown an increase in the prevalence of cryptorchidism. Apart from the rise in survival rates of premature babies, other recognised risk factors include excessive alcohol consumption during pregnancy, maternal exposure to pesticides, and even cosmetics.Such toxins are believed to mimic oestrogen, potentially causing feminisation and impairing the development of male characteristics during gestation.

During gestation, the male gonads develop next to the kidneys. Around seven months into fetal development, the testicles descend from the posterior abdominal wall through the inguinal canal to the scrotal sac, where the cooler temperature (about one degree cooler than the core body temperature) is vital for optimal spermatogenesis and testosterone production. Apart from sexual and reproductive health, warmer testicles risk abnormal cellular changes.

Men born with cryptorchidism generally have reduced fertility, though the reduction in sperm count is usually subtle, allowing many affected men to father children, with or without surgical intervention. Other complications include testicular torsion, where the spermatic cord twists, causing painful infarction of the gonad—ten times more common in undescended testes. Additionally, the misplaced testicles in the groin or inguinal canal are more susceptible to trauma against the pubic bone.

The most feared complication of cryptorchidism is cancer. About one in 500 men born with undescended testes develops testicular cancer, equating to a roughly 4-40 fold increased risk. The peak incidence occurs in the third and fourth decades of life, with the risk higher the closer the undescended testicle is to the body.

The typical treatment for cryptorchidism in children is orchidopexy, a procedure to bring the testes back to the scrotal sac. In adults, where the condition is rare, removal of the testicle (castration) is recommended to reduce the risk of cancer.

Locating the missing testicle, which can be done with ultrasound or MRI, is crucial for deciding whether to relocate or remove it. Marguerite de Valois, the daughter of King Henry II, once said: “The more hidden the venom, the more dangerous it is.”

In the case of a hidden gonad, this hidden danger cannot be ignored. While most men with cryptorchidism live to young adulthood without sexual or fertility issues, the potential malignant transformation of a hidden testicle can turn it into a “useless and yet poisonous lump.”