What is an undescended testicle?
When the testicle is formed it is located in the abdomen. In most boys it comes down into the scrotum by birth. Even after birth some testicles will still come down to the normal position in the scrotum (most of these come down by 4 months of age). If a testicle is not in the scrotum by 6 months of age, it is unlikely that it will come down. This testicle is called an undescended testicle. If the testicle can't be felt at all, it is called a "cryptorchid testicle." An undescended testicle requires surgery, called "orchidopexy," to place it in the scrotum.
Why is surgery necessary?
There are several reasons for placing an undescended testicle in the scrotum.
  1. Fertility: The temperature in the scrotum is less than up in the abdomen. We know that the sperm-producing cells in the testicle do better if they are in the cooler scrotal environment. Bringing the testicle down into the scrotum at an early age may improve the semen quality and chances of fertility later in life.
  2. Cancer: Undescended testicles have an increased chance of developing cancer later in life. It is unclear if early placement of the testicle in the scrotum decreases this chance of cancer. Placement of the testicle in the scrotum does permit self-examination of the testicle and earlier detection of testicular cancer should it occur.
  3. Hernia: A hernia sac is almost always associated with an undecended testicle. During the operation to bring the testicle down, this hernia is routinely identified and fixed.
  4. Protection: A testicle left in the abdomen may be at increased risk for injury or torsion (twisting and cutting of its blood supply).
  5. Cosmesis: Placement of the testicle in the scrotum makes the scrotum look normal.
When should surgery be performed?
Since some testicles that are not descended at birth will come down, it is best to wait until around 6 months of age. By this age if a testicle cannot be felt or is very high, it is unlikely that it will come down.
What is the surgery like?
In most cases the child will go home on the same day the surgery is performed. A small incision is made in the groin and on the scrotum. No stiches will need to be removed. In some boys when the testicle can't be felt (known as "cryptorchidism"), laparoscopy may be used. Laparoscopy involves making an incision in the abdomen and placing a lighted telescope through this incision to look for the missing testicle. If it is found (some testicles are absent), laparoscopy is used for bringing it down into the scrotum.
What are some of the specific complications with orchidopexy?
Wound infection or bleeding may occur with any operation. Injury to the testicular blood vessels or vas deferens (the tube that carries sperm) may occur when performing an orchidopexy. These structures are delicate and avoidance of injury requires delicacy and precision while performing the surgery. Rarely, there are some testicles that don't reach the scrotum after the first surgery and require a second surgery (about a year later) to bring them into their normal scrotal position.

Source: Christopher S. Cooper, MD, Pediatric Urologist
Last Reviewed: April 2011

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