Undescended Testes | Diagnosis & Treatments

How are undescended testicles diagnosed?

A primary care doctor will first perform a full genital examination and will try to locate the testicle if it is not in the scrotum. If one can't be felt, your son may be referred to a pediatric urologist or pediatric surgeon for a more complete examination and to rule out two related conditions — etopic testicles and retractile testicles.

Ectopic testicles

If the scrotum is empty, the doctor may first try to determine if your child has ectopic testicles, a related condition in which the testicle is somehow diverted from its normal pathway of descent. As a result, the testicle lies in an abnormal location outside this pathway. To check for this, the physician will feel the areas where ectopic testicles are sometimes located.

Retractile testicles

Retractile testicles move in and out of the scrotum. Your doctor may try to rule out this condition by trying to bring the testicle downward. If the testicle can be brought all the way into the scrotum, no treatment is required. If your doctor determines that the testicle is not ectopic or retractile, the diagnosis is usually an undescended testicle. Your child will then be referred to a pediatric surgeon or urologist for further evaluation.

What are the treatment options for undescended testicles?

If your son's testicle does not descend on its own before his first birthday, his surgeon will most likely recommend a type of surgery called orchiopexy to move the testicle down into the scrotum.

If the testicle can be felt in the groin, orchiopexy will probably be done through a small incision in the groin. The surgeon will free the testicle from its location in the abdomen and maneuver it into the scrotum. Children often go home later that day or the next morning.

If the testicle cannot be felt in the groin (this occurs in one out of five boys with an undescended testicle), the testicle may be in the abdomen or may simply be absent. Further exploration is necessary to make sure a testicle is not left in the abdomen in order to permit the testicle to function properly and to reduce the risk of cancer developing undetected in that testicle.

Surgery is highly recommended in order to reduce the risk of cancer or infertility, to improve your son's body image through adolescence and adulthood, and to reduce long-term effects and the risk of cancer or infertility. In most cases, doctors are able to repair an undescended testicle with a single, simple operation at around 12 months of age.

What are the complications associated with surgery?

Complications from surgery are relatively rare, but in some cases can include bleeding and infection. The most common complication — which is still quite rare — is when the moved testicle goes back up into the groin. In this case, doctors will need to perform another surgery. In very rare cases, a testicle can lose its blood supply, which will render it nonviable. It will then become scar tissue. But again, this is very rare.

Your son may feel some discomfort after his operation, but most boys feel better after about a day. Your doctor will probably recommend that your son avoid sitting on riding toys for about two weeks in order to prevent injury to the testicle. You can expect annual follow-up examinations so the doctor can check that the testicle is growing normally.

What is the long-term outlook for children with undescended testicles?

Undescended testicles may increase the risk of infertility, especially if both testicles are affected. However, boys who have one undescended testicle tend to father children at the same rate as those who are not affected by the condition at all. 

Boys who have two undescended testicles — a much lower percentage of patients — do have a significantly lower fertility rate. A child with undescended testicles is slightly more prone to develop testicular cancer, even after corrective surgery. However, surgery performed before puberty may reduce the risk of developing cancer. 

Parents should know that cases of cancer related to undescended testicles are rare. Having the surgery is important in that the testicle is located where a young man can palpate a mass if it should develop.