Undescended testicle is one of the most common birth defects seen, occurring in as many as 3% of boys at birth. Undescended testicles are more common in boys born prematurely. In many boys born with this problem, the testis may move down (descend) into its normal place in the scrotum during the first four months of life. It is important to remember that all testes first form in the child's abdomen, and descend into the scrotum. If a testis fails to come all the way down, it is called an undescended testis.

How are undescended testicles discovered?
Boys are examined after birth to check the position of the testicles. Since the testicle may descend on its own after birth, a boy with an undescended testicle is watched for at least 6 months. If the testicle does not come down, treatment is recommended. Sometimes, older boys will appear to have an undescended testicle when the testicles were previously thought to be normal. This finding often occurs because the testicle can be drawn upwards by a hyperactive muscle attached to the testicle. When this muscle contracts, the testicle is pulled up into the groin area and when it relaxes, the testis slides back down to its normal position. This sliding phenomenon is common in boys between 1 and 10 years of age, generally disappears after puberty, and does not require treatment.

However, sometimes a normally descended testis may retract and become fixed in a position that is too high. In this circumstance, treatment is indicated. Obviously, it is important to diagnose which condition your child has, but unfortunately it is not always simple and easy.

Will my son be able to have children?
With time, a testicle that is not down in the scrotum will start to lose some of its fertility potential. This is thought to be due to heat exposure from the testicle being so close to the body. If the testicle remains undescended, it may lose its ability to make sperm over time. Although many boys with a single undescended testicle are able to have children, most of those who have the problem on both sides are not. We believe that moving the testicle down into the scrotum early in life can improve the potential for fertility in all boys with an undescended testicle.

What other problems can occur?
A hernia is more likely to develop on the side of an undescended testicle. There is a small chance of a tumor developing after puberty in an undescended testicle, even if it has already been brought down into the scrotum. The risk may be as high as 2%. For this reason, it is important for all boys with an undescended testicle to be re-evaluated as a teenager and learn self-examination of the testicle.

Why do undescended testicles need to be treated?

We recommend doing surgery to bring the testicle into the scrotum for the following reasons:

• to improve its chances of making sperm in adulthood
• to improve the outlook of the child, so that he feels more normal
• to reduce the risk of problems from twisting or hernia
• to bring the testicle into a position where it can be felt just in case a tumor develops in it

How are undescended testicles treated?
At present, surgery is thought to be the best treatment because it is safe and effective. Hormone injections have been used, but the treatment requires a series of shots and usually does not work for testes that are truly undescended. At times, hormones are used to help decide if testicular tissue is present when no testis can be felt at the time of examination.

What type of surgery is used?
We recommend surgical correction (orchiopexy) through a small groin incision. This incision is made in the lower abdomen in the natural skin crease. The testicle is found and the blood vessels which feed it are freed from surrounding structures. Sometimes if your child’s testicle is unable to be palpated in the groin then we can use laparoscopic surgery to diagnose the location of the testicle and bring it down into the scrotum.

What happens after surgery?
The surgery usually takes about one hour to perform. Your child receives pain medicine (Tylenol with codeine) as needed. The stitches dissolve on their own and the dressing covering the incision will fall off in 1 to 2 weeks. Your child should not straddle anything or engage in any strenuous athletic activity for 3 to 4 weeks. You should plan to see the doctor 2 weeks after surgery.

What problems can occur after surgery?
Problems are uncommon after surgery. However, infection, bleeding, pulling up of the testicle into the groin or injury to the testicle or the ducts next to it can occasionally occur.

When to call the doctor.
Call the doctor if your child has severe or worsening pain, high fever, the scrotum continues to swell or there is drainage or bleeding from one of the incisions. Mild swelling and bruising of the scrotum and a low-grade fever are common after surgery.

What to expect 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 was brought down a long way, it is more common for the undescended testicle to be smaller than the opposite normal one in the first place. Rarely, the testicle pulls up again, and another surgery may be required. It is a good idea to teach your son to feel his testicles periodically after he goes through puberty to detect any sudden increase in size or shape. Your child should be checked at the time of puberty to make sure that the undescended testis is growing normally.