When we see a child with an undescended testicle, the ultimate diagnosis can be classified according to several different categories:
This is the most common factor resulting in the inaccurate diagnosis of an undescended testicle.
It is common in boys 5-6 years old and is due to a hyperactive cremaster muscle reflex. This is basically a variation of normal. In children from 1 year to 11 years of age, 80% of fully descended testes can withdraw from scrotum and leave an empty scrotum behind due to cremaster reflex. If a testicle can be milked down to the bottom of the scrotum, it is considered a retractile testis, and no further treatment is needed. This phenomena usually disappears by puberty.
Here the testicle is located above its natural position in the scrotum, but still outside the abdominal cavity. Tension from the external musculature of the body wall prevents normal descent into the scrotum.
Here the testicle is located inside the abdominal cavity residing in a position along its pathway of natural descent. In such a position, it is not amenable to future examination by a physician, and it is at risk of becoming cancerous.
Here the testicle may be found in regions not in the usual pathway of descent into the scrotum. Five major sites of ectopia are perineum, femoral canal, superficial inguinal pouch, suprapubic area, and contralateral scrotal pouch. The etiology is believed to be misdirected attachment to the scrotum.
Such a phenomena of absent testicle can be bilateral (affecting both sides). It is believed to be associated with in utero torsion, vascular insult, or agenesis.