Undescended Testis Surgery (Orchidopexy)

An undescended testicle, medically known as cryptorchidism, occurs when one or both testicles do not move down into the scrotum before birth. The testicle may remain in the abdomen, groin, or another abnormal position.

Orchidopexy aims to place the testicle inside the scrotum and secure it to reduce the risks associated with leaving it outside its normal position.

The surgical approach depends on the location of the testicle. A testicle located in the groin may often be treated through a small incision, while an abdominal testicle may require laparoscopic or other specialized techniques. In some cases, staged surgery may be necessary.

Conditions That May Require Orchidopexy

Undescended testis surgery may be considered for children with:

• One undescended testicle

• Bilateral undescended testicles

• Testicle located in the groin

• Testicle located inside the abdomen

• Testicle that has not descended naturally

• Retractile testicle that becomes persistently undescended

• Previously operated undescended testicle requiring further treatment

• Ectopic testicle in a location outside the normal pathway of descent

The timing of surgery is determined by the pediatric urologist based on the child's age, testicular position, and clinical findings.

An undescended testicle may not cause pain or other obvious symptoms. Common findings include:

• One side of the scrotum appearing smaller or empty

• Both testicles not being felt inside the scrotum

• An empty scrotal sac on physical examination

• Testicle felt in the groin rather than the scrotum

• Differences in scrotal development

Possible contributing factors include:

• Premature birth

• Low birth weight

• Abnormal testicular development

• Hormonal factors

• Genetic or developmental conditions

• Problems with the normal pathway of testicular descent

In many children, the exact cause cannot be identified.

Diagnosis usually begins with a physical examination by a pediatrician or pediatric urologist. The specialist evaluates whether the testicle can be felt and determines its position.

Additional investigations may be considered in selected cases, particularly when the testicle cannot be felt or when both testicles are undescended.

Treatment may include:

• Observation: Some testicles descend naturally during early infancy, so early monitoring may be appropriate.

• Orchidopexy: The testicle is surgically moved into the scrotum and secured in place.

• Laparoscopic orchidopexy: May be used when the testicle is located inside the abdomen.

• Staged orchidopexy: May be required when the testicle is positioned high in the abdomen or has limited blood supply.

• Hormonal evaluation or treatment: May be considered in selected children, particularly when bilateral undescended testes are associated with other developmental or hormonal concerns.

During orchidopexy, the surgeon carefully mobilizes the testicle and its blood supply before positioning it within the scrotum. The exact technique depends on the location and anatomy of the testicle.

Benefits of Undescended Testis Surgery

Potential benefits of orchidopexy include:

• Positioning the testicle within the scrotum

• Improving the ability to monitor the testicle during childhood and adulthood

• Supporting normal testicular development when performed at an appropriate age

• Potentially supporting future fertility potential

• Reducing complications associated with a persistently undescended testicle

• Improving scrotal symmetry in some children

• Addressing associated groin abnormalities when present

Orchidopexy does not guarantee normal fertility or eliminate the risk of future testicular problems. Outcomes depend on factors such as whether one or both testicles are affected, their original position, testicular development, and the timing of treatment.

Recovery & Follow-Up

Orchidopexy is usually performed under general anesthesia. Recovery depends on the surgical technique and the child's individual condition.

After surgery, the child may experience:

• Mild pain or discomfort

• Swelling or bruising around the scrotum or groin

• Temporary tenderness

• Mild changes in activity level

Children can generally return gradually to normal activities according to the surgeon's instructions. Strenuous activity, cycling, contact sports, or activities that could place pressure on the surgical area may need to be avoided for a period of time.

Follow-up appointments are important to confirm that the testicle remains in the correct position and is developing appropriately.

Is Orchidopexy Suitable for Every Child?

The need for surgery depends on the child's age, testicular position, development, and whether the testicle can be felt during examination.

The treatment plan may also depend on:

• Whether one or both testicles are undescended

• Location of the testicle

• Testicular size and development

• Previous surgery

• Associated congenital or genetic conditions

• Overall health

• Findings during physical examination or imaging when indicated

Early assessment by a pediatric urologist is important because prolonged undescended testis can be associated with reduced fertility potential and an increased lifetime risk of testicular cancer.