Undescended Testicle
DEFINITION
Undescended testis is a condition that affects between 1 in 20 and 1 in 50 boys. It is a condition where one or both testicles are not positioned in the scrotum at birth.
The testicle may be in the groin, in the abdomen, or very rarely in unusual positions such as the thigh or perineum (testicular ectopia).
This is different to testicles that move up and down (retractile testis) which is normal, or a testis that slowly rises out of the scrotum later in childhood (ascending testis).
GOALS OF CARE
The testicle should be returned to and secured in the scrotum as soon as possible, while avoiding injury to the testis, the vas deferens (sperm tube) and without compromising blood flow.
Early operation is associated with better outcomes, especially testicular growth.
OUTCOMES
There are four main outcomes of interest;
Testicular growth
Hormone production
Sperm production
Cancer prevention and surveillance
A testicle that is not in the scrotum will have poor growth, and if left uncorrected, will produce little or no androgens, and will not make sperm later in life. The risk of cancer is significantly higher in an uncorrected undescended testis, and if the testicle is not in a position where it can be easily felt (the scrotum) then there may be delayed detection of malignant changes in the testicle.
A testicle that can be felt by the surgeon may be put in the scrotum in a single operation and is unlikely to require any further surgery. The earlier this is done, the more likely the testicle will grow and work well. A testicle is in the abdomen may need more than one operation to get safely to the scrotum.
Keeping the testicle in the scrotum is an important part of life long surveillance, and all adult men should be performing self-examination of their testicles.
OUR APPROACH
For testicles that can be felt in the groin on the day of surgery, Dr Rob performs a single stage correction using an incision in the groin, and an incision in the scrotum, with dissolving sutures. This is the gold standard method and practiced by all paediatric surgeons.
For testicles that are in the abdomen, Dr Rob performs a two stage key hole approach which involves placing the testicle under ‘internal traction’ in the first operation, followed by a second procedure where the testicle is delivered to and secured in the scrotum by a combination of key hole and open operation.
Dr Rob was trained in this technique during his specialist overseas fellowship in 2024, and at the time of writing there are no other paediatric surgeons in Australia trained in and performing this method. The internal traction technique has been shown to offer excellent outcomes for abdominal testes, and has a number of benefits over the traditional method, including;
Preservation of the testicular artery and vein, which conserves blood supply and reduces testicular atrophy rates
Shorter time to second stage (6 weeks versus 6 months)
Earlier placement of the testis in the scrotum is associated with improved testicular function, especially spermatogenesis.
Aljani F, Rafi B, Alghamdi L et al. Testicular atrophy and growth post orchidopexy in pediatric patients: A systematic review. Journal of Pediatric Surgery Open 10 (2025) 100205
POST OPERATIVE RECOVERY AND CARE
Your child’s orchidopexy operation is perfomed as a day case. Your child will go home the same day as their operation. The operations take 60 to 90 minutes including anaesthetic time. The wounds will be closed with dissolving sutures, glue, and sometimes simple dressings. The glue and dressings can be left to fall off spontaneously, and the child can shower or have a bath the very next day.
Simple analgesia (Paracetamol and Ibuprofen) is usually all that is required, and only for a day or two.
The risks of complication are very low, which includes bleeding/bruising (1%), minor wound infections (1%), recurrence (<1%), and atrophy (1% for single stage, 10% for two stage).