Undescended Testicle

Normally, the testicles develop in the stomach of the baby before birth. Then they come down into the scrotum before birth. An undescended testicle occurs when one or both testicles fail to drop down before birth.

This happens fairly commonly in premature infants and occurs about three to four percent of the time in full-term infants. About 65 percent of these usually drop before the age of nine months.

Sometimes a child’s testicle will drop, but then retract or pull back into the scrotum. This is not considered an undescended testicle. This happens because of the strength of the muscles (cremasteric reflex) that retract the testicles before puberty. This is considered fairly normal and does not require surgery.

Testicles that do not drop by about one year of age should be examined by a surgeon. It is thought that by three years of age, if the testicles have not dropped, surgery should be done to prevent permanent damage to the testicles.

Testicles that do not descend naturally into the scrotum are considered abnormal throughout the patient’s life. These undescended testicles have a higher likelihood of developing cancer, regardless of whether they are surgically brought down or not.

Bringing the testicle down into the normal spot, the scrotum, maximizes sperm production and increases the odds of good fertility. It also allows for early detection of testicular cancer. In other cases, no testes can be found at all, even on surgical exploration. This happens before birth.

Usually the testicles will descend by age one without any help. If they do not, the first course of treatment can be hormone injections to stimulate movement and help the testicle descend. Surgery is the most common treatment. Recent research now suggests that surgery should be done early, rather than later, to prevent infertility. The surgery is called orchiopexy (ORKY-O-PEXY).

While the child is under anesthesia, an incision is made in the groin, where most undescended testes are located. The spermatic cord is found and freed to make sure it’s long enough. A small incision is made in the scrotum, and a pouch is created. The testicle is located and carefully pulled down into the pouch. The testicle is stitched into place, and the incisions are stitched closed. Orchiopexy is usually very successful with excellent prospects for fertility. The surgery usually is done on an outpatient basis, and bedrest is recommended for two to three days afterward. Strenuous activity, especially bike riding, usually is ruled out for about one month.

As with all surgery, there is a risk of infection or bleeding afterwards, as well as potential problems related to the anesthesia.

Pediatric urologic surgeons who treat undescended testicles:

Paul F. Austin, M.D.

Douglas E. Coplen, M.D.

For an appointment with a Washington University pediatric urologic surgeon, call (314) 454-6034.