Ascending Testicle: It Was Down as a Baby — Why Did It Move Up?

An undescended testicle is not always present from birth. In some children, the testicle is documented to be in the scrotum at birth and during infancy, but in later years it is found outside the scrotum, at the exit of the inguinal canal or within the canal, and it can no longer be brought down into the scrotum by hand, or does not stay there if it is. This condition is called an ascending testicle, or acquired undescended testicle.

The word "ascending" is somewhat misleading; the testicle does not actually climb upward. As the child grows, the distance between the trunk and the inguinal canal, and the scrotum, increases; if the spermatic cord does not lengthen enough to keep pace with this growth, the testicle relatively stays higher up. The most widely accepted explanation for why the cord fails to lengthen is that the extension of the abdominal lining that accompanies descent (the processus vaginalis) does not close completely and instead remains as a fibrous band, keeping the cord short.

An ascending testicle is painless and does not bother the child; it is usually noticed at a school examination, a routine check-up, or when the family sees one half of the scrotum looking empty during bath time. Some families describe it as "we can't see it down there anymore."

• One half of the scrotum that used to look full now looking empty
• The testicle not descending into the scrotum even during a warm bath
• The testicle not being able to be brought down at examination, or springing back up immediately once released
• A note during retractile testicle monitoring stating "it no longer stays down"

Some follow-up studies have reported that a portion of ascending testicles descend into the scrotum on their own during puberty; for this reason, some centers discuss monitoring until puberty. However, the approach of current guidelines (EAU/ESPU) and most pediatric urology centers is to plan orchiopexy once the diagnosis is made. The reasoning is clear: the testicle would otherwise remain in a warm environment for years, with no certainty about whether it will descend on its own, and the loss of sperm precursor cells continues during that time.

Because an ascending testicle spent its infant years in the scrotum, its tissue is usually well preserved, and surgical outcomes are better than for testicles that were positioned high from birth. Testicular atrophy (shrinkage) and re-ascent are uncommon; even so, follow-up is recommended a few times during the first year, and then yearly.

• During adolescence, testicular size and development are assessed, and the teenager is taught testicular self-examination. Because a history of undescended testicle raises cancer risk somewhat, this awareness lasts a lifetime; however, in an ascending testicle operated on in a timely manner, this risk is low, and follow-up continues with the same team into adulthood.