Cryptorchidism - Treating undescended testicles

Undescended testicles will usually move down into the scrotum naturally by the time your child is three to six months old. In some cases, this does not happen until your child is six to 12 months old.

If the testicles do not descend by your child's first birthday, it is very unlikely they will do so without treatment.

Orchidopexy

If treatment is necessary, surgery to reposition the testicle(s) into the scrotum is usually recommended. This type of surgery is known as an orchidopexy.

Ideally, surgery should be performed before your child reaches two years old. This is because waiting longer than this may increase a boy’s risk of developing fertility problems or testicular cancer later in life.

In most cases, an orchidopexy involves first making an incision (cut) in the groin to locate the undescended testicle. The testicle is then moved downwards and repositioned in the scrotum using a second incision.

A type of keyhole surgery known as a laparoscopy is sometimes carried out first to locate the testicle if it is higher in the abdomen (tummy). This involves passing a laparoscope (a small tube that has a light source and a camera) through a small incision in your child's abdomen. The laparoscope relays images of the inside of the abdomen to a television monitor.

When the procedure is complete, the incisions are usually closed with dissolvable stitches that don't need to be removed at a later date.

Orchidopexies are performed under a general anaesthetic, which means your child will be asleep during the procedure and will not feel any pain while it is carried out.

The operation usually takes about 40 minutes and is usually performed as day surgery, which means your child will be able to return home on the same day.

Recovery

Your child may feel a bit unwell for the first 24 hours after surgery. Feelings of nausea are a common side effect of general anaesthetic. They are nothing to worry about.

The following advice should help to speed up your child’s recovery time and reduce their risk of having any post-operative complications:

• Your child will need to have regular pain relief for a few days after the operation. Activities such as playing games, watching television and reading together may help to keep his mind off the pain.
• Encourage your child to drink plenty of fluids.
• Your child’s groin area may feel sore for a while after the operation. Wearing loose-fitting clothing will help, although wearing nappy is fine and can help protect the area.
• Follow your surgeon’s advice about washing and bathing.
• Your child should not ride a bicycle or use "sit-on" toys for a few weeks after the operation. This is to prevent the testicles travelling back up into the abdomen. Ask your surgeon for their advice about this.
• Your child should rest for a few days at home before returning to school or nursery.

When to seek medical advice

Be alert for any signs that the site of the surgery has become infected. These include:

• Your child being in a lot of pain, and the prescribed pain relief not working.
• Your child having a high temperature (fever) of 38°C (100.4°F) or above.
• The site of the surgery being red, inflamed or feeling hotter than the surrounding area.
• A discharge of fluid or pus appearing from the site of the surgery.

If you notice any of these signs and symptoms, contact your GP as soon as possible for advice.

Results of surgery

As a general rule, the closer the testicle is to the scrotum, the more likely surgery will be successful.

The success rate for treating palpable testicles located near the scrotum is estimated to be up to 90%.

The operation is slightly less successful in treating unpalpable testicles, depending on where the testicle is located. If the testicle is particularly far from the scrotum, two separate operations may be needed to complete the repositioning.

Risks of surgery

As with any type of surgery, an orchidopexy carries the risk of complications, some of which may need to be treated with further surgery.

Possible side effects and complications of an orchidopexy include:

• bleeding, swelling or bruising where the incisions were made
• the wound becoming infected
• the testicle moving up into the groin again
• testicular atrophy – where blood supply cannot sustain the testicle in its new position, which causes the testicle to wither away
• damage to the tube connecting the testicle to the urethra (vas deferens), which can make it difficult for sperm to pass through

Complications are more likely to occur after surgery to correct unpalpable undescended testicles.

Alternatives to surgery

An alternative to surgery is to use synthetic hormones that encourage the testicle move into the scrotum.

Hormone therapy is usually only recommended if your child’s testicle(s) are close to the scrotum. This is because the treatment is usually ineffective in treating unpalpable testicles that are located higher up.

Hormone therapy may also be recommended if both testicles are undescended and blood tests have shown that this is due to underlying problems with their hormones.

However, hormone therapy is less commonly used than surgery because it is effective in less than one in every five cases and there is a possible risk of long-term side effects. If hormone therapy is unsuccessful, surgery will usually be required.