Definition

Undescended testicle repair is surgery to correct testicles that have not dropped down into the correct position in the scrotum.

Alternative Names

Orchidopexy; Inguinal orchidopexy; Orchiopexy; Repair of undescended testicle; Cryptorchidism repair

Description

The testicles develop in the infant's abdomen as the baby grows in the womb. They drop down into the scrotum in the last months before birth.

In some cases, one or both testicles do not drop into the correct position. About one half of these cases will descend within the first year of life without treatment.

Undescended testicle repair surgery is recommended for males whose testicles do not descend on their own.

The surgery is done while the child is asleep (unconscious) and pain-free under general anesthesia. The surgeon makes a cut in the groin. This is where most undescended testes are located.

After finding the cord that holds the testis in the scrotum, the surgeon unties it from the tissue around it. This allows the cord to extend to its full length. A small cut is made in the scrotum, and a pouch is created. The testicle is pulled down into the scrotum and stitched into place. Stitches are used to close the surgical cuts.

In some cases, the procedure can be done laparoscopically. This involves smaller surgical cuts.

When the testicle is located very high, correction may require two stages.  The separate surgeries are done several months apart.

Why the Procedure Is Performed

This surgery is recommended for infants older than 1 year whose testicles have not descended into the scrotum (cryptorchidism).

An undescended testicle is different from a "retractile" testicle. In this condition, the testicle drops into the scrotum and then pulls back. Retractile testicles do not need surgery.

Risks

Risks of any anesthesia are:

• Reactions to medicines
• Problems breathing

Risks of any surgery are:

• Bleeding
• Infection

Risks of this surgery include:

• Shrinkage of the testicle or failure of the testicle to grow to normal size.
• Inability to bring the testicle into the scrotum, resulting in the removal of the testicle.

After the Procedure

Undescended testicle repair is successful in most cases. A small percentage of men will have fertility problems.

Men who have had undescended testicles should do monthly self-exams for the rest of their lives to look for possible tumors. Men with undescended testes have higher rates of testicular cancer than those with normal testicle development, even if they have a fully descended testicle on the other side. There is also a higher risk for testicular cancer in the other testicle that descended normally. Bringing the testicles down will make it easier to monitor for tumor growth in the future.

Outlook (Prognosis)

The surgery may be done on an outpatient basis. Bed rest is recommended for the first 2 to 3 days. Avoid strenuous activity, including bicycling, for at least 1 month.

References

Barthold JS, Hagerty JA. Etiology, diagnosis, and management of the undescended testis. In: Partin AW, Domochowski RR, Kavoussi LR, Peters CA, eds. Campbell-Walsh-Wein Urology. 12th ed. Philadelphia, PA: Elsevier; 2021:chap 46.

Eftekharzadeh S, Weaver J, Srinivasan AK. Laparoscopic orchiopexy. In: Bishoff JT, Kavoussi LR, Kavoussi N, Bishoff T, eds. Atlas of Laparoscopic and Robotic Urologic Surgery. 4th ed. Philadelphia, PA: Elsevier; 2023:chap 39.

Elder JS. Disorders and anomalies of the scrotal contents. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 560.