In many cases, the testicle(s) will descend into the scrotum by the time your child is four months old. If the testicle(s) do not descend by this time, treatment is usually recommended.
Orchidopexy
For most cases of undescended testicle(s), surgery to reposition the testicle(s) into the scrotum is usually recommended. This type of surgery is known as an orchidopexy.
Exactly when the operation is carried out will depend on your child’s health. Ideally, surgery should be performed between the age of six months and two years. This is because waiting longer than two years has been shown to increase a boy’s risk of developing fertility problems or testicular cancer.
Increasingly, orchidopexies are performed using a type of keyhole surgery known as a laparoscopy. This type of surgery causes less post-operative pain and has a faster recovery time than open surgery.
During the procedure, the surgeon makes a small incision (cut) in your child’s abdomen, before passing small surgical instruments through the incision in order to free the testicle from the surrounding tissue.
The testicle is then moved down the inguinal canal and repositioned in the scrotum using a second incision. The inguinal canal is then usually sealed to prevent the testicle from moving back out of the scrotum.
An orchidopexy is performed under a general anaesthetic, which means that your baby will not feel any pain during the operation. In most cases, surgery can be performed as day surgery, so your child will be able to return home on the same day.
Recovery
Your child may feel unwell for the first 24 hours after surgery. Feelings of nausea are a common side effect of general anaesthetic. They are nothing to worry about.
The following advice should help to speed up your child’s recovery time and reduce their risk of having any post-operative complications.
- Your child will need to have regular pain relief for three days after the operation. Activities such as playing games, watching television and reading together may help to keep his mind off the pain.
- Encourage (but don't force) your child to drink plenty of fluids.
- Your child’s groin area may feel sore for a while after the operation. Letting him wear loose-fitting clothing will help.
- Keep the operation site clean and dry, and avoid soaking the area during a shower or bath.
- Your child should not ride a bicycle or use "sit-on" toys, for one month after the operation. This is to prevent the testicles travelling back up into the abdomen.
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 (100.4F) or above.
- The site of the surgery being red, inflamed or feeling hotter than the surrounding area.
- A discharge of fluid, or pus, appearing 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, the more likely surgery will be successful.
The success rates for treating palpable testicles that are located near the scrotum are estimated to be between 80%-90%.
The success rate for treating unpalpable testicles is between 75%-90%, depending on where the testicle is located. If surgery fails, further surgery may be needed to reposition the testicle in the scrotum.
Complications of surgery
As with any type of surgery, an orchidopexy carries the risk of causing complications.
Testicular atrophy
The most serious complication of surgery is testicular atrophy. The blood supply cannot sustain the testicle in its new position, which causes the testicle to wither away. This is known as testicular atrophy, and it occurs in an estimated 5% of cases.
If testicular atrophy occurs, your child’s fertility should be unaffected as long as he still has one healthy testicle.
If necessary, cosmetic surgery can be performed to remove the affected testicle and place an artificial implant in your child’s scrotum.
Damage of the vas deferens
Another possible complication of an orchidopexy is that the vas deferens may be accidentally damaged.
The vas deferens is a tube that connects the testicle to the urethra. The urethra is the tube through which the sperm passes when a man ejaculates. Damage to the vas deferens occurs in an estimated 1% of cases.
If the vas deferens is damaged during surgery, further surgery is usually needed to repair it. If left untreated, it can cause fertility problems in later life.
Alternatives to surgery
An alternative to surgery is to use synthetic hormones that encourage the testicle move out of the abdomen and down into the scrotum.
Hormone therapy is usually only recommended if your child’s testicle(s) are close to the scrotum. This is because the treatment is usually ineffective in treating unpalpable testicles that are located in the inguinal canal or abdomen.
Hormone therapy may also be recommended if both testicles are undescended and blood tests have shown that this is due to underlying problems with their hormones.
If hormone therapy is unsuccessful as a treatment, then surgery will usually be required.
