Treating an undescended testicle

Before considering treatments your medical practitioner needs to find where the testicles are. This will determine how the testicle can be treated.

Where can undescended testicles be located?

I was born with an undescended testicle and you can read my story here. If you can’t feel your son’s testicles, don’t panic! The most common reason is they’re just hiding from sight (retractile), and will pop down again soon.

  • Retractile testicles are exactly what they sound like 🙂 They pull up into the body at times, particularly when touched or it’s cold. This is normal – 80% of children’s testicles can rise and leave an empty scrotum behind – and usually don’t need operating on, and your doctor will be careful to distinguish them from palpable testes. If a testicle can be milked down to the bottom of the scrotum, it is considered a retractile testis, and no further treatment is needed. If your son has retractile testicles it’s a good idea to monitor them until puberty, when they usually descend naturally as the muscle weakens. Find out more here.
  • Sometimes retractile testes may reascend into the body and become ‘stuck’. These are called Reascended testicles (medical name: “acquired cryptorchidism”). Research suggests 50-66% of all undescended testis surgically brought down are testicles which descended at one point (research), but you have to remember this would be based on cases which medical professions saw – and there will be plenty of retractile testicles they never know about. To put it another way: between 25 and 50% of retractile testicles a doctor knows about ascend and require surgery. For this reason you need to keep an eye on your son’s retractile testicles to ensure they don’t reascend.
    There may be over-surgicalisation occurring: two studies in the Netherlands reported spontaneous pubertal descent in 57-71% of cases. This is fascinating research.
  • Palpable testes are located low-down in the stomach. and can be felt by the GP or consultant, usually right at the top of the scrotum. They are likely to always be here, but you can frequently massage them down and feel them ‘pop’ under your fingers or be grabbed in the scrotum. They include gliding testicles (high scrotal testicles), prescrotal and inguinal testicles.
  • Impalpable testes are somewhere in the body, or may not be present at all. Your child will need to undergo an ultrasound or laparascopic surgery to discover where they are.

Here’s a diagram showing where the testicles can be located: Cryptorchidism

The medical names given to the places where your son’s undescended testicle(s) are located are:

  1. High scrotal (gliding) testis
  2. Superficial inguinal region (prescrotal)
  3. Inguinal canal
  4. Intra-abdominal
  5. Ectopic (outside line of normal descent)
An empty right scrotum empty
The right scrotum has an undescended testicle. It is empty and flat.

Does your child have palpable testicles?

You can try out the palpable testes examination yourself, using these instructions quoted from Docimo SG et al. 2000 (see Figure 2 in their paper for photos of this being done):

“Testicular examination of the infant and young child requires a two-handed technique. One hand should start at the hip and gently sweep along the inguinal canal, aided by surgical lubricant or warm soapy water, if necessary. A true undescended or ectopic inguinal testicle will be felt to ‘pop’ under the examiner’s fingers during this maneuver. A low ectopic or retractile testicle will be felt by the opposite hand as it is “milked” into the scrotum. The ectopic testicle will immediately spring out of the scrotum when it is released. The retractile testicle will remain momentarily in the scrotum until further stimulation causes a cremasteric reflex. To prevent retraction, the fingers first should be placed across the abdominal ring and the upper portion of the inguinal canal, obstructing ascent. Examination while the child is in the squatting position or in a warm bath is also helpful.”

For Palpable testicles

Hormone therapy was once available (at least outside the UK) but are now appear to be rarely used. According to WebMD:

Hormone therapy alone stimulates the testicles to complete their descent into the scrotum in less than 20 out of 100 cases. Reascent occurs in about 15 out of 100 males who are treated.

Which – when you add in the potential side effects of giving hormones – pretty much says why it’s not widely used!

Surgical correction

Surgery is the go-to treatment for an undescended testicle. I know it’s scary to think of your son having an operation, but it’s the best help you can give him.

There’s no definite ‘best age’ to do an operation for cryptorchidism, but it does appear the earlier the better. Over the last 40 years as surgical techniques have improved the average age has decreased from 6-7 years to under 18 months.

A preoperative image showing the presumed location of the scrotal incision (black arrow), external inguinal ring (white arrow) and testis position (circle).
A preoperative image showing the presumed location of the scrotal incision (black arrow), external inguinal ring (white arrow) and testis position (circle).

The surgical procedure is called and orchiopexy (or orchidopexy – I don’t know why but there are two common spellings) and most commonly involves making a cut in the groin, freeing the testicle (and repairing a hernia if present), making a cut in the scrotum and stitching the testicle in place. If you want to see what happens, these videos give a good overview (not recommended if you’re squeamish and your son’s just about to have the procedure!)

What’s going to happen?

This is the clearest video I’ve found – done on an older boy so you can see what’s going on more easily:

There’s an even better video here, but you have to be logged in to YouTube to view it.

If you are squeamish, here’s a 3D computer generated video of what goes on, which provides a very clear explanation of all forms of undescended testicles.

Find out what your child will experience. Read my story of going through the operation

Genital surgery can lead to psychological issues. Your surgeon won’t warn you about this, but it’s in the medical textbooks.

Single-incision orchidopexy

If you’re lucky your child’s surgeon will use this! In 1989 Bianchi and Squire developed a single incision technique to bring down undescended testicles which could be palpated down and felt at the top of the scrotum (those are ‘high scrotal’ or ‘prescrotal’ mentioned above). This gets rid of the larger incision on the groin and only uses one incision in the scrotum. The technique has been studied (and again) but doesn’t appear to be commonly practiced in the UK – I guess it takes a while for new surgical techniques to catch on.

For impalpable testicles

For boys whose testicles can’t be felt and are located higher inside the body, the surgery is more complicated. Approximately half will have an intra-abdominal testis (a testis that is located high in the inguinal canal and not descended). For the other half, the testicle will have atrophied (died) or will not be present. For all children with testicles that can’t be felt, laparascopy will be used as it allows the surgeon to quickly determine the location of the testis, and do the right operation to fix it.

For impalpable testicles an orchiopexy is successful in most cases, but removing the testicle (orchiectomy) may be necessary in more challenging cases or when the patient has an atropic testis.

Sometimes two operations can be required. If the testicle is undescended because it has short blood vessels attached, and won’t reach the scrotum, your surgeon will need to move the testicle down as far as it will go, attach it and then do another operation to move it to the scrotum about 6 months later when your son (and his pipework) has grown. This is known in the profession as a Fowler-Stephens orchiopexy.

Help, my son has two undescended testicles!

Having a son with bilateral undescended testicles is incredibly scary. All sorts of questions flash through your head – “Is he normal?” “Will he ever be able to have children?”. Well, the good news is that while 30% of boys with this have fertility problems (compared to 7% of the general population), fertility is better the earlier the operation is done. Remember the studies that are quoted (like I just did) consider men who had the operation 10+ years ago, when they would have been 3 or older at the time of the operation.

So don’t worry. I know, easier said than done 🙂  What will be more scary is that unlike the rest of us, you will probably have to go through two (or more) operations.

For good reason, your surgeon is likely to want to bring down each testicle in a separate operation. This is for a good reason – in the unlikely event the testicle got infected after the operation and it had to be removed, your son would only lose one – and not both – of his testes.

For all of this, if you’re after medical reading then this paper covers it all in detail (and dry, doctor’s language!).

Got questions? Get in contact.

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20 thoughts on “Treating an undescended testicle

  1. I had orchiopexy for one undecented testis when I was 6.now I am 22 years old.my one testis is not fully in scruntum..it just above scruntum.I was panic about it.please help me.I am also never know that surgery is successful or failed?indicate the position of testis after surgery..

  2. I can see one of my son testicles, but when I examine him I feel two. A doc say its there and a nurse said its half way in the scrotum. Lately a doc didn’t feel it but I feel it two days after half way in the scrotum. Is it normal or will he need surgery?

    1. Hi Deneice, what a question 🙂 I am not a qualified medical professional but… Prepare yourself, I suspect your son will need surgery. However, it could be retractile, though it sounds like it’s always at the top of his scrotum or above.

      Can you ‘milk’ it down into his scrotum using the technique described above?

      You need to get your son referred to a pedriatric urologist who will be able to make a diagnosis and let you know for certain.

  3. Hi, my son just had a surgery to bring down his left testi but the blood vessel is short and could not bring it to the sac. The doctor said there will be 3 possibilities: pop back, disappear because the blood vessel stretch becomes smaller and smaller, stay where it is now. We are still waiting for the follow up appointment but I am very worried. It sounds like the chance of losing is more. So what is succesful rate for testi to stay there and need another surgergy. Just want to her some good news for encouring myself.
    Thanks!

    1. Hi Haianh,

      Sorry to hear this, it must be stressful for you! It sounds like a situation where the surgeon often does two operations: the first to fix the testicle part-way down so the blood vessels are stretched and made to grow; and then a second operation to bring it into the scrotum. This is called a Fowler-Stephens two-stage orchiopexy. Sadly sometimes it doesn’t work, but in my experience doctors are usually far more negative than they should be 🙂

  4. Both of my son’s testicles can be seen and felt in his scrotum, but 1 does not “hang” like the other does when it is warm. Its a bit higher, and possibly a bit firmer. Also the fat pad above is a bit larger on that side. Is this an undescended testicle that will need surgery?

    1. Hi there 🙂 How old is your son? I’m no doctor but I see a few possibilities: it’s perfectly normal (both testicles always hang differently); it’s a weakly retractile testicle so sits higher; or it’s on a bit of a short blood vessel and will disappear inside him as he grows, becoming an “acquired undescended testicle”.

      When your son’s scrotum is warm, can you ‘milk’ the testicle all the way to the bottom of his scrotum, matching the other?

      Either way, keep an eye on it until puberty to make sure it doesn’t disappear, and see a doctor if you’re concerned.

  5. Hi, am Rogers 37yrs married with one son aged 7,i have a problem of left testicle having stuck in the abdomen. it has affected the size of my pen also bending on one side. Help me out of this.

  6. My son had the orchiopexy surgery on one testicle when he was 7 years old and now he is almost 13 years old going through puberty. His undecsended testicle isn’t hanging at all compared to the other one and doesn’t seem like it’s growing. Also I believe the nerve was short when the surgery was done. I know ur not a doctor but after reading this it sounds like he may need to be seen by his urologist and possible 2nd surgery? Or is this normal aftereffects of this surgery?

    1. Hey Megan, it does sound like he needs to be seen by a doctor. Do you know why they did the surgery when he was 7 and not earlier? It isn’t going to grow well after being inside him for so long, so it will always be smaller and not hang as well.

      Don’t give up hope though! My undescended testicle which was brought down started growing much later than the other, and continued increasing in size until I was ~18 or 19. Guess it was a real late developer 🙂

      How did your son find having the surgery aged 7?

  7. Hi there ,

    I have been reading all these problems with testical which are really helpful . I have a issue with my sons right undesend testical when he was young, doctor checked him nd said they could not find his right testical digital we thought may be it didn’t develop cause he born at 35 weeks but no doctor told us that he needs to be checked up of can be found in later life , now when he is 12 . They found the testical in deep inguinal ring nd said testical hasn’t developed the size is only 10mm by 6mm and can’t be brought down cause he is going through puberty it’s too late to do orchiopexy . They said it needs to be taken out I’m really worried about it . I was wondering if it’s brought down it might start working please can you give me some advice ? I don’t want them to taken out his testical . Is there any med , massage can be helpful to bring this testical development ? The left testical normal but the problem with the right side testical.

    1. Deepika, I feel for you, it’s worrying to find this out. Unfortunately the doctors are right, due to the risk of cancer it needs to be removed. If it’s brought down it will not start working, it doesn’t work like that. It is bad that your doctor never told you that it needed to be checked and that your doctor never scheduled an appointment with a surgeon when your son was young. The best news I can give is that as his left testicle is normal, your son is likely to have near-normal chances of conceiving a child. Only one testicle is required to produce enough sperm.

  8. Hi, My son is now 22 months old. His testicles seems to be moving up and down. By moving up i mean they up on the sides of penis and like 70% they are on the bottom portion of the scrotum. He was examined two times by the doctor and theu said it is okay.
    But we parents are still not comfortable.
    Thanks

    1. Hi, this sounds like a normal retractile testicle. As it spends 0% of the time at the bottom of the scrotum you have nothing to worry about. I had one of these, and once I reached puberty it stayed at the bottom of the scrotum.

      Keep an eye on it, as the instructions above about a retractile testicle say — it could become an acquired undescended testicle if you are unlucky. But I don’t expect it will, and your son will grow up to be healthy!

  9. Hi. I am 15 years old and I was born with an undescended left teste. I was never told
    Either that it needed to be brought down and the doctors planned to take it out when I was 12 but right before they were going to schedule surgery it dropped on it’s own. Now they haven’t said anything since, is it possible that it will work? It is much smaller but it’s grown a little bit through puberty. I’m just not sure where to go from here.

    1. Hi Dustin, I can understand your concern. The good news is that whether it works or not, you still have a right testicle which has always been descended, and that is likely to work without any problems 🙂

      As to whether your left one will work: as it dropped on its own it cannot have been a true undescended testicle, more likely a retractile testicle. There’s a chance it will produce sperm. But remember you only need one testicle functioning to get someone pregnant – relax, and talk to your doctor if you’re worried.

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