Undescended testicles, also known as cryptorchidism, are painless. Some will eventually descend into their proper position without treatment within the first three to four months of life. The condition does, however, increase the risk of infertility. Normally, by lying in the scrotum, the testicles stay about 6 degrees cooler than they do inside the body's abdominal cavity. The warmer termperatures inside the body can impair the development of the testicles and the production of fertile sperm. Undescended testicles are also more prone to testicular cancer, even after corrective surgery.

During this exam, the doctor will inspect the child's scrotum to determine whether its size and development are normal. The scrotum of a patient with an undescended testis can appear underdeveloped. If the scrotum is empty, the doctor may first try to determine if your child has ectopic testes, which is commonly confused with undescended testes. An ectopic testis involves a testicle that was somehow diverted from the normal pathway of descent and as a result, lies in an abnormal position outside this pathway. To check for this, the physician will feel the areas where ectopic testes are sometimes located.

The doctor may also try to rule out a retractile testis if the testis can be felt but not seen in the scrotum. To do this he may try to bring the testis downward. If he can bring it all the way into the scrotum, it is retractile and requires no treatment. If the doctor determines that the testis is not ectopic or retractile, the diagnosis is usually an undescended testis. Your child will then be referred to a pediatric surgeon for further evaluation.

Surgery does not diminish a child's long-term risk for malignancy, but it does move the testis into a place that allows for routine self-examination, which could lead to early detection of any abnormalities later in life.

If the testicle can be felt in the groin, a procedure called orchiopexy will probably be done through a small incision in the groin. After making the incision, the surgeon will locate the testis. After the testis is freed, a scrotal pouch is created and the testis is placed into this pouch.

In about one out of five boys with an undescended testis, the testis cannot be felt in the groin.This may mean the testis is not present or that it is in the abdomen. It is very important to be sure of whether a testis is present or absent so that one is not left in the abdomen. This is to permit the best function of that testis, as well as reduce the risk of cancer in that testis developing without being detected. Some testes have descended into the scrotum, but have not grown well and are not functional. They are best removed.

It has been found that laparoscopy, a surgical procedure that involves looking into the abdomen with a minute telescope is an excellent way to determine where a testis is if it cannot be felt, and to help in moving a testis into the scrotum to permit the best growth and development possible for that testis. Ultrasound, CT scan and MRI have not been found to be as effective in locating testes in the abdomen. It is important to recognize that even with the testis being moved into the scrotum by surgery, it may not develop well due to it not having been a very good testis to begin with.

With laparoscopy, the testis can be located and if indicated, the first stage in bringing it into the scrotum can begin. At a later time, usually six months, laparoscopy can be used to bring a testis that is in the abdomen down to the scrotum. Children may go home later that day or the next morning. For more information on laparascopy, see Minimally Invasive Surgery.

Your son may feel some discomfort after the surgery, but most boys feel better after about a day. Your doctor will probably recommend that your child avoid riding toys for about 4-6 weeks in order to prevent injury to the testicle. You can expect annual follow-up examinations, so that the urologist can check to be sure the testicle is growing normally.