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Testicles, undescended Content Supplied by NHS Choices
Introduction

Undescended testicles are a common childhood condition where a boy's testicles are not in their usual place in the scrotum.

It's estimated that about one in every 25 boys are born with undescended testicles.

In most cases, no treatment is necessary, as the testicles will usually move down into the scrotum naturally during the first three to six months of life. However, around one in 100 boys has testicles that stay undescended unless treated.

The medical term for having one or two undescended testicles is unilateral or bilateral cryptorchidism.

When to see your GP

Undescended testicles are usually detected during the newborn physical examination carried out soon after birth, or during a routine check-up at six to eight weeks.

See your GP if at any point you notice that one or both of your child's testicles are not in the normal place within the scrotum.

Undescended testicles aren't painful and your child isn't at risk of any immediate health problems, but they should be monitored by a doctor in case treatment is needed later on.

What causes undescended testicles

During pregnancy, the testicles form inside a baby boy's abdomen (tummy), before slowly moving down into the scrotum about a month or two before birth.

It's not known exactly why some boys are born with undescended testicles. Most boys with the condition are otherwise completely healthy.

Being born prematurely (before the 37th week of pregnancy), having a low birth weight and having a family history of undescended testicles may increase the chances of a boy being born with undescended testicles.

Diagnosing undescended testicles

Undescended testicles can usually be diagnosed after a physical examination. This will determine whether the testicles can be felt near the scrotum (palpable) or if they can't be felt at all (impalpable).

This physical examination can sometimes be difficult, so your doctor may need to refer your child to a paediatric surgeon.

No further scans or tests are needed to locate the testicles if they can be felt by the doctor. If they cannot be felt, part of the initial surgical treatment (see below) may involve keyhole surgery (a diagnostic laparoscopy) to see if the testicles are inside the abdomen.

How undescended testicles are treated

If the testicles haven't descended by six months, they're very unlikely to do so and treatment will usually be recommended.

This is because boys with untreated undescended testicles can have fertility problems in later life and an increased risk of developing testicular cancer.

Treatment will usually involve an operation called an orchidopexy to move the testicle(s) into the correct position inside the scrotum. This is a relatively straightforward operation, with a good success rate.

Surgery is ideally carried out before 12 months of age. If undescended testicles are treated at an early age, the risk of fertility problems and testicular cancer can be reduced.

Read more about treating undescended testicles.

Treating undescended testicles

Undescended testicles will usually move down into the scrotum naturally by the time your child is three to six months old.

If the testicles don't descend by six months, it's very unlikely they will do so without treatment, so a surgical procedure to reposition one or both testicles will normally be recommended. This procedure is called an orchidopexy.

The operation should ideally be carried out before your child is 12 months old. This is because waiting longer than this may increase a boy's risk of developing fertility problems or testicular cancer later in life.

Orchidopexy

In most cases, if the testicle can be felt in the groin, a simple orchidopexy can be performed. This involves first making an incision (cut) in the groin to locate the undescended testicle. The testicle is then moved downwards and repositioned in the scrotum through a second incision.

If the testicle is thought to be higher in the abdomen (tummy), a type of keyhole surgery known as a laparoscopy is sometimes carried out to locate it before it's repositioned. This involves passing a laparoscope (a small tube containing a light source and a camera) through a small incision in your child's abdomen.

A testicle found inside the abdomen can occasionally be brought down to the scrotum in a single operation, but sometimes this has to be done in two separate stages.

In cases where the testicle is impalpable (in the abdomen), there's a small possibility that there's no testicle at all on that side, either due to it not having developed properly or it having twisted and withered away early in life. This would be confirmed during the laparoscopy.

When the procedure is complete, the incisions are usually closed with dissolvable stitches that don't need to be removed.

Orchidopexies and laparoscopies are performed under a general anaesthetic, which means your child will be asleep during the procedure and won't feel any pain while it's carried out.

The operation normally takes about 40 minutes and is usually performed as day surgery, which means your child will be able to return home on the same day.

Recovery

Your child may feel a bit unwell for the first 24 hours after surgery as a result of the anaesthetic. This is nothing to worry about.

The following advice should help to speed up your child's recovery time and reduce their risk of developing any complications:

  • Your child will need to have regular pain relief for a few days after the operation. Activities such as playing games, watching television and reading together may help to keep his mind off the pain.
  • Encourage your child to drink plenty of fluids.
  • Your child's groin area may feel sore for a while after the operation. Wearing loose-fitting clothing will help, although wearing a nappy is fine and can help protect the area.
  • Follow your surgeon's advice about washing and bathing.
  • Your child should not ride a bicycle or use "sit-on" toys for a few weeks after the operation. This is to prevent the testicles moving back up into the abdomen. Ask your surgeon for their advice about this.
  • Your child should rest for a few days at home before returning to school or nursery.

When to seek medical advice

Be alert for any signs that the site of the surgery has become infected. These include:

  • your child being in a lot of pain, and the prescribed pain relief not working
  • your child having a high temperature (fever) of 38C (100.4F) or above
  • the site of the surgery being red, inflamed or feeling hotter than the surrounding area
  • a discharge of fluid or pus from the site of the surgery

If you notice any of these signs and symptoms, contact your GP as soon as possible for advice.

Results of surgery

As a general rule, the closer the testicle is to the scrotum originally, the more likely surgery will be successful.

The success rate for treating palpable testicles (located near the scrotum) is estimated to be higher than 90%. The operation is slightly less successful in treating impalpable testicles (located in the abdomen).

Risks of surgery

As with any type of surgery, an orchidopexy carries the risk of complications, some of which may need to be treated with further surgery.

Possible side effects and complications of an orchidopexy include:

  • bleeding, swelling or bruising where the incisions were made
  • the wound becoming infected
  • the testicle moving up into the groin again
  • testicular atrophy - where blood supply cannot sustain the testicle in its new position, which causes the testicle to wither away
  • damage to the tube connecting the testicle to the urethra (vas deferens), which can make it difficult for semen to pass through

In general, complication rates are low. The main risk is atrophy (loss) of the testicle, and the chances of this increase the further the testicle has to be moved to get to the scrotum.


'He was bouncing around the day after the operation'

When he was two years old, James Addison had two operations to reposition his undescended testicles, says his mother, Laura.

"When James was born, both of his testicles were down. But at the nine-month check, our health visitor noticed that his testicles weren't in the scrotum. I was terrified. We hadn't noticed, which made me feel terrible.

"It was very confusing, because at birth, they were there. We hadn't realised that testicles could move in this way. Our GP examined James, but couldn't find his testicles, so he referred us to a consultant.

"When the consultant examined James and palpated (felt) the area, he could feel James's testicles just above his penis. James was given an ultrasound so that the consultant could see their exact position. We were told that if his testicles hadn't appeared by the time he was 24 months old, they would perform surgery.

"The first operation was just after James's second birthday. It was done as day surgery. Because James was the youngest patient that day, he was first on the list. He'd had a cannula (a small tube) inserted. When they put in a spinal block (anaesthetic), he became unconscious very quickly.

"The operation took less than an hour. The doctors did one testicle at a time. This was partly because James was young, but also because if both testicles were operated at the same time and one became infected, the infection could spread to the other testicle.

"After the operation, James was very sleepy and took ages to wake up. He had to eat and drink, and show that he could pass urine before he could go home. As soon as he did that, we were allowed to leave. He had the operation around 9am. We left the hospital at 1pm, so it was pretty fast.

"We gave him Calpol for a few days, but he was running around the next day. I thought he would be in pain, but he didn't seem to be affected.

"In fact, it bothered him so little that when he had the second operation on his other testicle six months later, we didn't give him too much pain relief afterwards.

"We're not sure what the final outcome will be. James's testicles haven't properly descended yet. One is moving around a lot. We know that it's in his scrotum sometimes, when he's having a warm bath, for example. We haven't yet seen the other testicle, but hopefully it will come down and stay down at some point soon. We've been told that it's unlikely he will have two fully working testicles. We'll just have to wait and see."

 
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