Undescended Testicle

Signs and Symptoms

Testicles are the male reproductive organs that produce sperm and the male hormone, testosterone. The scrotum is the sac that contains the two testes. In most boys, the testicle descends into the scrotum by itself. When the testicle doesn't descend, we recommend surgery after the first year of life. Our experience in the last three years with over 250 boys with undescended testes shows that outpatient surgery is safe and effective, with excellent outcomes.

Problems associated with undescended testes include:

• Infertility
• Inguinal hernia
• Testicular tumor
• Psychological and cosmetic problems
• Injury of the undescended testes and torsion or twisting of the testis

Diagnosis

Undescended testes are suspected when one or both of the testes can't be felt when the scrotum is examined. The scrotum may appear flat and small. Some undescended testes will descend during the first few months of life, and the diagnosis can be made with confidence by re-examination at six months of age. Sometimes an undescended testicle is confused with a retractile testicle, which is a "normally" descended testicle that is pulled out of the scrotum by an overactive cremasteric muscle reflex, an automatic reflex that occurs when skin on the front inner thigh is stroked. This commonly occurs in boys between the ages of 2 and 7. Treatment isn't required for retractile testes because boys usually outgrow it by puberty.

Treatment

Surgery is performed at our outpatient surgery center. An incision will be made in the groin on the affected side. After the undescended testicle is found, fibrous bands are released, peritoneal attachments lining the abdomen are divided, and the sac around the testicle is removed. This allows the testicle to be pushed down into the scrotum and stitched into the proper position.

Your son will have an additional incision in the scrotum as well. If we can't feel where the testis is located, we look inside the abdomen with a special scope to define the presence of a testicle. Then, with the use of the scope, a tube with a miniature camera on it that allows us to see inside the body, we will proceed with an operation called orchiopexy to place the testicle in the scrotum. When indicated, laparoscopic surgery using small incisions, a scope and miniature instruments, avoids the need for a larger incision in the groin and is performed as an outpatient procedure.