Overview
Undescended testis (cryptorchidism) is a common condition affecting roughly 3% of newborn boys, in which one or both testicles fail to descend from the abdominal cavity into the scrotum during pregnancy or the first weeks after birth. In some cases the testicle descends on its own during the first months of life, but if it doesn’t, surgery becomes necessary to protect the child’s future fertility and reduce other health risks.
Undescended Testis vs. Retractile Testis
Parents often confuse two very different conditions:
- Undescended testis — the testicle stays in the abdomen or inguinal canal and never reaches the scrotum on its own. It always needs medical evaluation and usually surgery, since leaving it untreated can reduce fertility or raise the risk of testicular cancer.
- Retractile testis — the testicle is normally present in the scrotum but moves up and down in response to temperature changes or physical activity. It usually settles on its own over time without needing surgery.
Telling the two apart requires a careful clinical exam, so any absence or irregularity in the scrotum is worth having assessed by a specialist pediatric surgeon.
Causes of Undescended Testis
The exact cause isn’t fully understood, but several factors raise the likelihood: genetic factors and family history, premature birth, low birth weight, maternal diabetes during pregnancy, maternal smoking or secondhand smoke exposure, hormonal disorders in the child, and Down syndrome.
Risks of Leaving It Untreated
Leaving the condition untreated can lead to: reduced future fertility (from the testicle being exposed to higher-than-normal body temperature), an increased risk of testicular cancer, testicular torsion (an emergency requiring immediate treatment), and it is sometimes associated with an accompanying inguinal hernia.
Pre-Op
After the diagnosis is confirmed, the child is prepared for surgery under full general anesthesia. It is important to follow these points before the surgery date:
Confirming the diagnosis
The surgeon examines the child to distinguish a true undescended testis from a retractile testis, since the latter usually needs no surgery at all.
Locating the testicle
The surgeon determines whether the testicle is in the abdomen or the inguinal canal, and whether one or both sides are affected, since this determines the most suitable surgical technique (open or laparoscopic).
Full general anesthesia
The surgery is performed under full general anesthesia, taking 30 to 60 minutes depending on the location and number of testicles involved and the technique used.
Best surgical timing
Doctors recommend performing the surgery between 7 and 9 months of age, to protect future fertility and reduce the risk of long-term complications.
Post-Op
Undescended testis surgery aims to bring the testicle down and fix it in the scrotum, protecting it and ensuring it functions normally going forward. Below is what happens after surgery and the expected recovery period.
Immediately After Surgery
The child is moved to the recovery room until the effects of general anesthesia wear off. Mild swelling or bruising in the scrotum is normal, along with some pain managed by doctor-prescribed painkillers. In most cases the child goes home the same day without needing to stay overnight.
Recovery Period
Recovery typically takes one to two weeks, varying slightly depending on the technique used (open surgery or laparoscopy) and how closely the parents follow the doctor’s instructions.
Signs of a Successful Surgery
- The testicle can be felt in its normal position within the scrotum on examination.
- No pain during the child’s normal movement or activity.
- Normal wound healing without redness or discharge.
- No signs of infection, such as elevated temperature.
- The doctor confirming the testicle’s position is stable at follow-up visits.
Possible Complications
Rare — success rates exceed 98% when the surgery is performed by an experienced pediatric surgeon. Rare complications include bleeding, infection, nausea and dizziness from the anesthesia, or the testicle not settling properly, requiring a second surgical intervention. It’s delaying treatment — not the surgery itself — that raises the risk to future fertility.
Aftercare
- Keep the surgical area clean per the doctor’s instructions.
- Avoid strenuous activity or rough play for the period the surgeon specifies.
- Dress the child in loose clothing to avoid rubbing the surgical area.
- Keep all follow-up appointments to confirm the testicle’s position remains stable.
Symptoms Requiring Immediate Medical Attention
- Significant swelling or increasing redness of the scrotum.
- A noticeable rise in the child’s temperature.
- Sudden, severe pain (which may indicate testicular torsion — a medical emergency).
- Bleeding or abnormal discharge from the wound.
Frequently Asked Questions
What is the goal of undescended testis surgery?
The surgery moves the testicle down into the scrotum and fixes it in place, so it can develop normally and stay protected from the higher body temperature inside the abdomen.
Can undescended testis be treated without surgery?
There is no alternative to surgery. Some children's testicles descend on their own during the first months of life, and regular monitoring alone is enough in those cases — but if that doesn't happen, surgery is the only option.
What is the best age for undescended testis surgery?
Surgery is recommended at 7 to 9 months of age. Delaying surgery can affect future fertility and increases the risk of testicular tumors.
How long does the surgery take, and does the child need to stay in hospital?
The surgery takes no more than 60 to 90 minutes, and the child can usually go home the same day once he's recovered from anesthesia and been confirmed stable.
How long is recovery after undescended testis surgery?
Recovery takes one to two weeks, and may vary depending on the technique used (open surgery or laparoscopy) and how closely the parents follow the doctor's instructions.
Does undescended testis surgery affect future fertility?
If performed at the right time (7-9 months), the chances of normal future fertility are high. If treatment is delayed until puberty, or never performed, fertility can decline.
Can the testicle become undescended again after surgery?
Recurrence after surgery is very rare, and usually results from limited surgical experience. Choosing a specialized pediatric surgeon is essential.
Is undescended testis surgery dangerous?
There is no life-threatening risk when it's performed by an experienced pediatric surgeon and specialized anesthesia team. In fact, not having the surgery, or delaying it, is the real risk.
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Last updated: December 5, 2024