Undescended Testes

Undescended testicle, or cryptorchidism (the failure of one or more testes to descend from the abdomen into the scrotum) is fairly common. The condition may occur at birth in males, and more often in boys born prematurely. It may also run in families. In many boys, the testis will eventually move down to the normal position, generally within the first six months of life.

Diagnosing Undescended Testes

Boys are examined after birth to check the position of the testicles. Once an undescended testicle is discovered, it is watched for about six months. If it does not come down, surgical treatment is recommended.

Sometimes older boys will appear to have an undescended testicle even though previous examinations were normal. This is not uncommon, since it is a normal reflex for the testicle to pull upwards under some conditions, starting later in infancy and continuing until puberty. These "retractile" testes do not need surgery if they are clearly down in the scrotum at least part of the time.

Impact on Reproductive Function

After about one year of age, a testicle that has not settled in the scrotum will start to lose some if its fertility potential. If it remains undescended, it may lose its ability to make sperm entirely. Although most boys with one undescended testicle will be able to have children, many of those who have the problem on both sides may be infertile. Moving the testicle to the normal position early in life reduces this risk of infertility.

Additional Problems

A hernia is more likely to develop on the side of an undescended testicle. This is because the testicles form in the abdomen, and descend before birth in most cases. In undescended testicles, the connection between the testicle and the abdomen often fails to close as it normally does. Also, torsion (twisting) of the testicle is more likely to occur, which can result in loss of the testicle. There is also a slightly increased risk of testicular cancer in testicles that are undescended. However, since testicular cancer is rare to begin with, it is still uncommon in men who had an undescended testicle. The risk is higher if the testicle was in the abdomen, and there is some evidence that bringing the testicle down during early childhood may reduce this risk.

Surgical Treatment

Surgery is recommended to bring the testicle into the scrotum in order to:

  • Improve its chances of producing sperm in adulthood
  • Prevent body-image concerns in the child
  • Reduce the risk of twisting and hernia
  • Provide optimal position for regular cancer screening

An undescended testicle may require laparoscopic surgery to determine its location or to verify its existence. If the testicle cannot be felt at all, the belly is examined with a laparoscope (a special telescope used to look inside the body) through a three millimeter incision. If the testicle did not ever form in the first place, the laparoscopy is conclusive. If a testicle is seen in the belly, it can usually be brought down into the proper position through two additional small incisions using
miniature instruments.

If the testicle can be felt in the groin, an orchidopexy can be performed. This is an outpatient surgery under anesthesia in which one or more incisions are made through the groin. The tissue supporting the testicle is divided, any hernia is repaired, and the testicle is placed in the scrotum through another tiny incision.

What to Expect After Surgery

Your child will usually be ready to go home about an hour after the procedure is completed. He will receive numbing and pain medicine during surgery, and as needed afterwards. He will be able to eat and drink right away. The stitches dissolve within two weeks. He should not ride toys or do strenuous sports during this time. The child will usually see the doctor for a postoperative visit about two weeks after surgery. Complications are rare, but can include bleeding, infection, loss of the testicle, and injury to the intestines (if laparoscopy is done).

When to Call the Doctor

Call the doctor if your child has pain that cannot be controlled by medicine, if he experiences high fever, severe swelling or drainage from the incision. Mild swelling and bruising are normal, and low-grade fever (less than 101.5 degrees) is common after surgery. However, never hesitate to call if you have concerns or questions.

As Your Child Grows

Your doctor may want to check the testicle after healing is complete. Although the testicle can shrink after surgery, particularly if it was very high, it is common for an undescended testis to be smaller than the normal one. In rare cases, the testicle becomes trapped in scarring from the surgery, possibly even pulling back up into the groin, and another surgery may be required. It is a good idea to teach your son to examine his testicles periodically after puberty to detect any sudden change in size or shape.

Pediatric Urology at Cedars-Sinai

Children are affected by different urologic conditions than adults, and their smaller bodies respond differently to anesthesia and surgical incisions. For these reasons, the Cedars-Sinai Urology Academic Practice is guided by the philosophy that pediatric patients are best evaluated and treated by pediatric specialists. Andrew Freedman, MD, the Urology Academic Practice's pediatric urologist, devotes his practice to the evaluation and treatment of children. Board certified in Pediatric Urology he offers broad experience in minimally invasive laparoscopic procedures. The majority of his procedures are conducted on an outpatient basis, with both outpatient and inpatient surgeries attended by specialized pediatric anesthesiologists.

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