Patient Education

How the testicles normally descend?

The testicles are the male sex organs that produce sperm and male hormones. They form near the kidneys. As the fetus grows in the mother's womb, the testicles move down through the groin into the scrotum. Normally they are in the scrotum before birth.

When a testicle doesn't descend?

Sometimes a testicle doesn't fully descend into the scrotum before birth. Instead, it stops somewhere along the normal pathway between the kidney and the scrotum. Or it may stray from this pathway. What causes this is not known. An undescended testicle is most common in premature babies, and mostly only one testicle is affected.

A retractile testicle

A retractile testicle is sometimes confused with an undescended testicle. A retractile testicle has descended into the scrotum. However, when the muscles that attach to the testicles contract, the testicle is pulled back up into the groin. As the boy matures, the testicles will remain in the scrotum. Treatment is rarely needed.

An undescended testicle

Your baby's doctor may detect an undescended testicle at birth. More often, it is found when the baby is a few months old. The doctor will most likely check the testicles over the next few months to see if it descends on its own. If not, surgery is needed to bring the testicles down into the scrotum.

Locating an undescended testicle

The undescended testicle can usually be felt during a physical exam. Your baby lies on his back for the exam. An older child may be asked to squat. The doctor places his or her fingers on the child's groin and then gently moves them toward the scrotum until the testicle is felt. If the testicle can't be found with an exam, imaging studies, such as ultrasound or other special tests may be needed.

Watchful waiting

The doctor will most likely wait for a few months to see if your son's testicle will descend on its own. The closer the testicle is to the scrotum, the greater the chance it will come down. If the testicle does not descend on its own, it can still be treated. If both testicles have not descended, or if the testicle is above the groin, the doctor may advise tests and earlier treatment.

Why treatment is needed?

If the testicle doesn't descend on its own, it should be treated. Your doctor will discuss the best time with you. The longer a testicle remains outside the scrotum, the more likely it is that it will produce fewer sperms. An undescended testicle has a higher risk of cancer. This is true even after the testicle is brought down into the scrotum. The testicle down makes a problem easier to find.

An undescended testicle can leave a small tear (hernia) in the wall between the abdomen and the groin. Hernia needs to be treated to prevent future problems.

Surgery

The testicle is brought down into the scrotum during surgery. Rarely, a testicle is malformed and must be removed.

You and your son are asked to arrive at the hospital or surgery center on the previous night/morning of surgery. An opening (incision) is made in the groin or abdomen. Another small incision is made in the scrotum.

The testicle is detached from the tissue around it. Then it is brought down and stitched to the wall of the scrotum. In case the testis could not be fully brought down it may be fixed just above the scrotum.

In case the testis could not be brought down and is defective or too small it may have to be removed.

After surgery

Your son is likely to go home on the same day after surgery. Rarely, if there is some swelling then the doctor may ask you to stay overnight. He should be feeling better in 2 to 3 days.

The doctor may prescribe medication to relieve any pain your child has. Be sure to use it as directed. The stitches will dissolve or be removed 7 to 10 days after surgery.

Follow up

Your son should have his testicle examined for several years after the operation to see whether the testicle is growing well.

But rest assured that your son could lead a normal adult's life.

In cases where the testicle had to be removed, an artificial testicular prosthesis of appropriate size may be inserted when the child is older. These testicular implants are easily available.