Undescended Testis

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Undescended testis is a disorder, present at birth, when one or both testes have failed to descend into the scrotum. It is recognised by looking at the scrotum, which may appear underdeveloped and empty on one or both sides. This is one of the checks that are performed when your child is first born and will be repeated at the six week and nine month checks.

During a child’s development in the womb, the gonads develop near the kidneys and they descend under a combination of hormonal and physical control (‘drop’) to their final resting place. In females, descent of the ovary ends within the pelvis. In the male infant, gonadal descent continues down into the scrotum.

Click here for a Child friendly cartoon about Orchidopexy If one or other testis is not in the scrotum by the nine month check, it is essential that your child is referred to a Surgeon with an interest in paediatric surgery. The paediatric surgeon will assess the child and will discuss with you the clinical findings and a treatment plan. No surgery will be required if the testes are found to be retractile but are otherwise easily coaxed down into the scrotum. An orchidopexy will be recommended (dropping the testis) if the testis can be felt in the groin but is not able to be coaxed down into the scrotum.

If surgery is recommended, it is my practice to perform the operation as soon as possible after the age of 18 months. Testes that are not down in the scrotum by one year of age will not descend unaided. Most of the children who have an orchidopexy, on one or both sides, are treated as day case patients. There is usually some discomfort for a couple of days following the procedure, but on the whole children bounce back quickly from operations. I usually advise that the child remains off school for one week but can resume normal activities when they feel comfortable to do so. Organised sports and activities should be avoided for one month in case the child feels pressured to continue participation, despite discomfort. It is my practice to follow up my patients six weeks after their operation.

The problems that may be associated with undescended testis include infertility, an increase risk of testicular tumour in later years, inguinal hernia, testicular torsion, increased risk of injury and occasionally psychological effects. The surgery to correct the condition is not without potential risk and complication. This specifically includes damage to the testicular artery, resulting in the testis failing to develop or indeed shrivelling up, and also damage to the vas deferens (sperm tube). Obviously every effort is made to avoid these complications.

Occasionally the testes are not palpable at all, in which case, consideration would be given to a laparoscopy, which is a telescope operation looking for the testis within the abdomen. The Surgeon may also request special tests if they feel that this is appropriate.