Diagnosis
With an undescended testicl*, surgery may be needed to find the problem and treat it. There are two main types of surgery:
-
Laparoscopy. A small tube with a camera on it is placed through a small cut in the belly. Laparoscopy is done to locate a testicl* in the stomach area.
- Open surgery. This uses a larger cut to look inside the stomach area or groin to find the undescended testicl*.
The surgeon might be able to fix the undescended testicl* during the same procedure. But another surgery might be needed. Sometimes, laparoscopy might not find an undescended testicl*. Or it might find damaged or dead testicl* tissue that doesn't work, and the surgeon removes it.
If a baby's testicl*s can't be found in the scrotum after birth, more tests may be needed. These tests can determine if the testicl*s are absent — meaning not there at all — rather than undescended. Some health issues that lead to absent testicl*s can cause serious problems soon after birth if they're not found and treated.
Imaging tests, such as an ultrasound and MRI, usually aren't needed to find out if a baby has an undescended testicl*.
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Treatment
The goal of treatment is to move the undescended testicl* to its proper place in the scrotum. Treatment before age 1 might lower the risk of health problems linked with an undescended testicl*, such as infertility and testicular cancer. Earlier treatment is better. Experts often recommend that surgery take place before the child is 18 months old.
Surgery
Most often, an undescended testicl* is fixed with surgery. The surgeon moves the testicl* into the scrotum and stitches it into place. This is called orchiopexy (OR-kee-o-pek-see). It can be done through a small cut in the groin, the scrotum or both.
The timing for when your baby gets surgery will depend on many factors. These include the baby's health and how hard the procedure might be to do. Your surgeon will likely suggest doing the surgery when your baby is somewhere between 6 and 18 months old. Early treatment with surgery seems to lower the risk of later health problems.
In some cases, the testicl* might be damaged or made of dead tissue. The surgeon should remove this tissue.
If your baby also has an inguinal hernia, the hernia is repaired during the surgery.
After surgery, the surgeon monitors the testicl* to see that it develops, works right and stays in place. Monitoring might include:
- Physical exams.
- Ultrasound exams of the scrotum.
- Tests of hormone levels.
Hormone treatment
With hormone treatment, your child is given shots of a hormone called human chorionic gonadotropin. This could cause the testicl* to move to the scrotum. But hormone treatment often is not recommended, because it's much less effective than surgery.
Other treatments
If your child doesn't have one or both testicl*s — because one or both are absent or were removed during surgery — other treatments might help.
You might think about getting your child testicular prostheses. These artificial implants can give the scrotum a regular appearance. They're placed in the scrotum with surgery. They can be implanted at least six months after a scrotum procedure or after puberty.
If your child doesn't have at least one healthy testicl*, you may be referred to a hormone expert called an endocrinologist. Together, you can talk about future hormone treatments that would be needed to bring about puberty and physical maturing.
Results
Orchiopexy is the most common surgery to fix a single undescended testicl*. It has a success rate of nearly 100%. Most of the time, the risk of fertility problems goes away after surgery for a single undescended testicl*. Surgery with two undescended testicl*s brings less of an improvement. Surgery also might lower the risk of testicular cancer, but it doesn't get rid of the risk.
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Lifestyle and home remedies
Even after surgery, it's important to check your baby's testicl*s to make sure they develop properly. You can check the position of the testicl*s during diaper changes and baths.
When your child is about to reach puberty, the two of you can talk about what physical changes to expect. During the talk, you can explain how your child can check the testicl*s without your help. Your child should do a self-exam each month. This is a key skill to help find lumps and other possible symptoms of tumors early. Make an appointment with your child's doctor if your child notices any unusual changes in the testicl*s.
Coping and support
Your child might be sensitive about how the scrotum looks without one or both testicl*s. It's common to feel anxious about looking different from friends or classmates, especially in a locker room where students undress. The following tips might help:
- Teach your child the right words to use when talking about the scrotum and testicl*s.
- Explain that there are often two testicl*s in the scrotum. If one or both are missing, explain what that means and why your child is still a healthy kid.
- Tell your child that having an undescended testicl* isn't an illness.
- Discuss whether a testicular prosthesis is a good option for your child.
- Help your child practice how to explain the undescended testicl* to any bullies or kids who ask questions.
- Buy your child loose-fitting boxer shorts and swim trunks. These might make the undescended testicl* harder to notice when changing clothes and playing sports.
- Be aware of signs of worry or shame. For example, your child might stop playing a sport they used to enjoy.
Preparing for your appointment
An undescended testicl* often is found at birth. Your family doctor or pediatrician will check on the condition during well-baby visits and regular exams for your child.
To prepare for your appointment, write down a list of questions to discuss with your child's care team. Questions might include:
- How often should I schedule appointments?
- How can I safely check the scrotum at home to watch for any changes in the undescended testicl*?
- When would you suggest seeing a specialist?
- What kinds of tests will my child need?
- What treatment options do you suggest?
- Are there any brochures or other printed material that I can take home with me? What websites do you suggest?
Feel free to ask other questions during your appointment.
What to expect from the doctor
Your child's doctor will check the groin. If a testicl* isn't in the scrotum, the provider will try to find it by lightly pressing against the skin. A lubricant or warm, soapy water may be used for the exam.
If the testicl* can be felt somewhere in the inguinal canal, your child's doctor may try to move it gently into the scrotum. It might be an undescended testicl* if:
- It moves only partway into the scrotum.
- The movement seems to cause pain.
- The testicl* goes back to its original location right away.
It's most likely a retractile testicl* if it can be moved somewhat easily into the scrotum and it stays there for a while.
If your baby's testicl* hasn't moved down or can't be found by about 6 months of age, you may need to see a specialist for more exams. You might see a doctor who is trained in children's genital and urinary tract problems, called a pediatric urologist. Or you might go to a doctor who's trained to do surgeries on children, called a pediatric surgeon.
By Mayo Clinic Staff
