Overview

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 1 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 3 to 6 months of life.

But around 1 in 100 boys has testicles that stay undescended unless treated.

The medical term for having 1 or 2 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 6  to 8 weeks.

See your GP if at any point you notice that 1 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 tummy (abdomen) before slowly moving down into the scrotum about a month or 2 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 6 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.

Retractile testicles

In most boys, the testicles can move in and out of the scrotum at different times, usually changing position as a result of temperature changes or feelings of fear or excitement.

This is a separate condition known as retractile testicles.

Retractile testicles in young boys aren't a cause for concern, as the affected testicles often settle permanently in the scrotum as they get older.

But they may need to be monitored during childhood because they sometimes don't descend naturally and treatment may be required.

See your GP if you notice that your child's testicles are not within the scrotum. Your GP can carry out an examination to determine whether your child's testicles are undescended or retractile.

Treatment

Undescended testicles will usually move down into the scrotum naturally by the time your child is 3 to 6 months old.

If the testicles don't descend by 6 months, it's very unlikely they will do so without treatment.

In this case a surgical procedure called an orchidopexy will be recommended to reposition 1 or both testicles.

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 2 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.

This is either because it didn't develop properly or it 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 1 hour 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:

• They'll 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 their mind off the pain.
• Encourage your child to drink plenty of fluids.
• Their 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 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 (testicular atrophy)
• 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 loss (atrophy) of the testicle.

The chances of this increase the further the testicle has to be moved to get to the scrotum.