Undescended testicle in a baby: when does he need an operation?

What an undescended testicle is

Before birth, the testicles form inside the tummy and move down into the scrotum. In some boys, one or both have not finished the move by birth. It is more common in babies born early. The scrotum on that side may look flat or small, and the testicle may be felt in the groin or not at all.

It is different from a retractile testicle, which sits in the scrotum but is pulled up into the groin by a muscle when the child is cold or touched. A retractile testicle usually does not need an operation, but should be checked by a doctor as the boy grows.

Why the operation is done early

A testicle needs to be in the cooler scrotum to develop normally. Mainstream guidance advises surgery in the first year or so of life because:

• A testicle left in the groin or tummy is more likely to have reduced sperm production later
• The risk of testicular cancer in adult life is higher, and a testicle in the scrotum is easy to check
• An undescended testicle is more prone to twisting and injury
• There is often a hernia alongside it, which is repaired at the same time
• It avoids worry and embarrassment as the boy grows

What the operation involves

Orchidopexy is done under general anaesthetic by a paediatric surgeon or urologist, usually as a day case. Through a small cut in the groin, the surgeon frees the testicle and brings it down into a small pocket in the scrotum. If the testicle cannot be felt at all, the surgeon may first look inside the tummy with a keyhole camera, and sometimes the operation is done in two stages.

Your child must not eat or drink for some hours before; you will be given exact fasting times. One parent usually stays with him until he goes to sleep and is there when he wakes.

After the operation

Most children are back to their usual selves within a few days. Give regular pain relief as advised. Keep the wound clean and dry, and avoid straddle toys, bicycles and rough play for about two weeks. Sponge baths are usually advised for the first few days. The surgeon will see him again to check the testicle has stayed down.

Call the surgical team if he has a fever, the wound becomes red or leaks, the scrotum becomes very swollen, or he is in increasing pain.

If your son is older

In Nigeria many boys are seen later than ideal, sometimes at school age. It is still worth having the operation, both to check for and reduce problems and so the testicle can be examined. In a teenager or adult the surgeon may discuss whether to bring the testicle down or remove it. If both testicles cannot be felt, or there is also hypospadias, the doctor will arrange further tests before surgery.

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