Undescended Testicle

Diagnosis

Diagnosis of an undescended testicle often involves a physical exam shortly after birth. If the testicle is not felt in the scrotum, further evaluation may be needed. In some cases, surgery is required both to locate the testicle and to treat the condition.

There are two main surgical approaches:

• Laparoscopy: A small tube with a camera is inserted through a small cut in the abdomen to locate the testicle. If possible, the surgeon fixes the undescended testicle during the same procedure. Sometimes, a second surgery is needed if the testicle is not easily moved into place. If the testicle is found to be damaged or nonfunctional, it may be removed.

• Open surgery: This involves a larger incision in the abdomen or groin to locate the undescended testicle.

If a testicle cannot be found after birth, additional tests may be needed to determine if it is absent rather than undescended. Imaging tests such as ultrasound or MRI are generally not required to confirm the diagnosis, as physical examination and surgical exploration provide more accurate information.

Treatment

The main goal of treatment is to move the undescended testicle into the scrotum. Treating the condition before age 1 can help reduce future risks, including infertility and testicular cancer. Most experts recommend completing surgery before 18 months of age.

Surgery
Surgery is the most effective treatment. The procedure, called orchiopexy, involves moving the testicle into the scrotum and stitching it in place. It can be performed through small incisions in the groin, scrotum, or both.

Key points about surgery:

• The timing depends on the child’s overall health and the complexity of the case.

• If the testicle is damaged or consists of dead tissue, it will be removed.

• Any associated inguinal hernia can be repaired during the same operation.

After surgery, the testicle’s health and position are monitored through:

• Physical exams

• Ultrasound scans of the scrotum

• Hormone level tests

Hormone treatment
In some cases, hormone therapy using human chorionic gonadotropin (hCG) may be considered. This can help move the testicle into the scrotum, but it is less effective than surgery and not commonly recommended.

Other treatments
If one or both testicles are missing or were removed, additional options may include:

• Testicular prostheses to give a natural scrotal appearance

• Endocrinology consultation for hormone therapy to support puberty and physical development

Results
Orchiopexy has a high success rate, with nearly all cases of single undescended testicles successfully corrected. Fertility outcomes are typically good when treatment occurs early. In cases involving both testicles, improvement in fertility is less certain. Surgery also reduces, but does not eliminate, the long-term risk of testicular cancer.