Undescended Testicle

What is an undescended testicle?

Normally before your child is born the testicle descends from very near the kidney in the upper abdomen to the scrotal sac. In some children, particularly those that are born prematurely, this will not occur. In this case, the testicle may be located in a site either high up in the inguinal canal (groin) or in the abdomen. In some children, particularly premature infants, the testicle may continue to descend into its normal position in the scrotum. In general, if this does not occur by 1 year of age, it will never descend without a surgical procedure.

Why does my son need to have this corrected?

There are several reasons for a child to benefit from such an operation. First, the scrotal sac is the safest place for a testicle. If the testicle is located above this site, it may be a greater risk for injury due to torsion (twisting off of its blood supply) or blunt trauma. Second, an undescended testicle is associated with an increased risk of testicular cancer. Although bringing the testicle down into the scrotum will not remove that risk, it will allow physicians to be able to palpate the testicle for any abnormalities. Finally, undescended testicles have an associated hernia sac. This hernia will need to be corrected at the same time as the testicle is brought down.

What else it could be?

Occasionally, the muscle attached to the testicle (the cremasteric muscle) pulls the testicle up into the groin so that it cannot be felt or seen. If this is the case it will usually not need surgical correction, but should be monitored yearly by your pediatrician to insure that it can be brought into the scrotum.

Sometimes, a testicle never formed or lost its blood supply and died before your child was born. In this case, when your surgeon explores your child, they may not find a testicle. In this case, little else will be done during this surgery. Your surgeon will console you with regard to what to expect and do knowing child has only one testicle. Your child may opt to have an artificial testicle implanted as they become an adolescent.

Orchidopexy: How is the surgery done?

As shown in the figure below, the testicle is dissected up and the blood supply and duct (vas deferns) are freed up and mobilized. The hernia is repaired, and the length to bring the testicle into the scrotum is done by dissecting the vessels and ducts.

Afterwards, the testicle is brought down into the scrotum. Surtures are placed to make sure that the testicle does not pull back up out of the scrotum.

What to expect after the surgery

Your child will receive a complete set of instructions on wound care after the surgery. He will be uncomfortable for a few days after surgery, and will generally miss 2 to 4 days of school. He most likely should not participate in physical education or sports for at least 2 weeks after surgery. He will be given pain medication for discomfort, and will notice discomfort if he is too active. He will have sutures on his scrotum where the testicle has been brought down. These sutures should have a triple antibiotic ointment placed over the area at least 3 times a day. In general, these sutures will fall out, without the need for suture removal, in the first 7 to 10 days after surgery.

Why is it important to continue to follow up with a physician even after the testicle is placed in a correct position?

Even though the testicle is placed in an anatomically correct position, your child is at risk for two major problems. The first is an increased risk of testicular cancer. This risk involves both testicles even if only one was found to be involved. In general, most children will never develop a cancer, however, the risk is greater than the general population and your child will need follow up. Such cancers usually do not occur before the teenage years, but the risk continues throughout adulthood. Because of this, your child will need to see a physician on a yearly basis for a testicular exam. Additionally, as your child gets older, they should be taught how to perform a monthly testicular examination. This is the best way to detect any abnormal lumps or bumps in the testicle, and get medical treatment as soon as possible.

The second risk is that your child will have a decreased ability to father a child compared to the general population. Although he still has testicles, and he will go through puberty, the testicles may not function as well as normally descended ones. Although he still has a good chance of be able to father, this will be a subject which you will need to make sure he becomes aware of as he enters adulthood.

This information is provided by the University of Michigan Department of Surgery, Section of Pediatric Surgery and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. For additional health information, please contact your health care provider or our offices.