Risk of infertility in adults with undescended testicles

The article is professionally consulted by Master, Doctor Vo Thien Ngon - Urologist, Department of General Surgery, Vinmec Da Nang International General Hospital.

An undescended testicle is the most common developmental defect in men. The incidence of undescended testicles in boys is about 3% - 4% at birth, usually in low birth weight, premature babies, and twins. However, undescended testicles are still very dangerous in adults if not treated early.

During the fetal period, the fetal testicles will be located behind and close to the kidneys. By the time the fetus is 8 months old, both testicles will move from the abdomen, through the groin, and down the scrotum before the baby is born.
Undescended testicle is a condition in which a baby boy is born with one or both testicles that do not descend into the scrotum, the testicles are still located in the abdomen, groin or only partially down the scrotum. Therefore, the testicles are usually not palpable in the scrotum.
Possible clinical forms are testes located in the abdomen, in the deep inguinal cavity, in the inguinal canal and outside the superficial inguinal ring. The undescended testicle can be palpable if located in the groin, the cases of undescended testicle are located. in the abdomen cannot be touched. Usually, only one testicle is affected, but in about 10% of children, both testicles fail to descend into the scrotum.

In many cases, the testicles will automatically descend into the scrotum before the baby is 3 months old. If the testicle is not in the scrotum until the baby is 6 months old, it is very difficult for the testicle to descend automatically and needs to be treated. After 1 year of age, the undescended testicle cannot move down to the scrotum on its own, but begins to have structural and functional changes in the direction of worsening. The testicles will begin to shrink and complications will appear.
In some cases, patients let the condition last, and it is very late after puberty that they go to the doctor. At that time, the undescended testicles in adults usually have shrunk. Treatment at this time is surgery to remove the testicle because the testicle has lost function and also to prevent the risk of cancer of the undescended testicle.
In all cases of testicular cancer, testicular cancer occurs in the undescended testicle accounts for 10%. The risk of cancer of an undescended testicle is 40 times higher than that of a testicle in a normal position. If the undescended testicle is still relatively large and is located low near the scrotum, it is still possible to save the testicle with surgery to bring the testicle down into the scrotum, but careful monitoring is needed because of the risk of cancerous growth.
Manifestations of undescended testicles in adults:
Self palpation in the scrotum without testicle or palpable tumor in the inguinal canal with raised tumor or palpable only one testicle. Underdeveloped scrotum: The higher the undescended testicle, the less developed the scrotum.

An undescended testis is often associated with a smaller diameter of the seminiferous tubules, and a higher degree of testicular fibrosis (fibrosis is higher in children older than 1 year compared with children younger than 1 year). Histological changes of the undescended testicle can affect sperm and cause male infertility. If you only have one undescended testicle, you can still have children, but there will be a higher risk of undescended testicle cancer and other risks.
In case of undescended testicles on both sides, the risk of male infertility is very high. These men often have no sperm in the semen analysis results. There are even cases where it is impossible to have sex due to severe male hormone deficiency, weak physical condition, greatly affecting life, activities and psychophysiology.

An undescended testicle should be treated as soon as the patient is 1 year old. Because after 1 year, the testicles are at risk of atrophy and complications such as testicular torsion, cancer and infertility if the testicles are hidden on both sides. For undescended testicles in adults, it is necessary to be treated as soon as the disease is detected, do not delay because the risk of infertility is very high.
Surgery to treat undescended testicle is a conservative surgery, so it should be done with experienced surgeons.
Undescended testicle can be treated surgically by laparoscopic surgery with the technique of sacral anesthesia (epidural anesthesia through the sacral fissure) very effectively. This technique is routinely applied at Vinmec Danang International General Hospital. This technique is performed by a team of qualified medical professionals with many years of experience in the treatment:
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