Undescended Testicle

During pregnancy and during the developmental period of a male fetus, his two testicles are located within his abdomen. Shortly before birth, they begin their natural path, descending from the abdominal cavity, through the inguinal canal, down to the scrotum. There are instances in which the testicle does not traverse this natural path, and remains in the abdominal cavity or in the inguinal canal, and is then defined as an undescended testicle.

One testicle alone may be undescended, or they may both be undescended (which occurs in 30% of cases of the undescended testicle). An undescended testicle is, in fact, the most common birth defect in male babies, occurring in about 4% of full-term births. Premature births increase the chance for this, but it is important to remember the bottom line: in most instances, the testicle will descend to the scrotum by itself naturally within a year of the baby’s birth. Only if it does not descend to the scrotum after this time will treatment be needed – using medicines or operation.

The importance of treating an undescended testicle at a young age is related to a number of factors, two of which have central importance: Firstly, the testicles must be in the scrotum, outside of the body, to provide them with conditions suitable for their development. If they remain within the body, they will not develop properly, causing future fertility problems. Secondly, an undescended testicle has been found to be at significantly higher risk for cancer than a “normal” testicle, and maneuvering it to its correct location dramatically reduces these risks.

General information about undescended testicle

An undescended testicle can be treated with hormonal medicines when the testicle is close to the scrotum. The hormone hCG has been discovered to encourage the “migration” of the testicle to its natural place, and this option will therefore sometimes be considered; one of the reasons for this would be to avoid operation at a young age.

If the medicinal treatment does not help solve the problem, or if the testicle is deep inside the inguinal canal or even in the abdominal cavity, an operation will be needed. During the operation, the testicle will be brought down to its place and fixed in the scrotum, helping it to remain in place.

Preparation for undescended testicle procedure

An operation to treat an undescended testicle is performed under general anesthesia, necessitating several hours of fasting. The clinical staff will guide you as to how this time can be spent pleasantly. Also, you should bring examination results from your pediatrician with you to the hospital. Your child is likely to undergo an additional careful examination, which is not painful, performed by hospital staff.

The course of the procedure

An undescended testicle is usually discovered during the first months of the infant’s life, in most cases at one of the first examinations that he undergoes immediately after birth. In such cases, an operation will not be performed immediately, as mentioned above: the medical team will give an opportunity for the testicle to descent naturally to its place. Only if the testicle remains undescended after the boy has reached the age of one year will an operation probably be needed?

If the testicle is in the inguinal canal, the physician can usually palpate and feel it. In such a case, a small incision will be made in the upper part of the groin, through which the testicle will be brought down from the inguinal canal to the scrotum. The testicle will be fixed in the scrotum with special sutures so that it will not go back up into the inguinal canal, and so that testicular torsion will not occur, which could impair the flow of blood to the testicle and cause necrosis.

In many instances, an undescended testicle also causes a hernia if the inguinal canal does not close. In such a case, parts of organs in the abdominal cavity could “slip” into the groin, causing pain and even damage in advanced stages. If a hernia is discovered, the physician will repair it, only then completing the surgical procedure.

If the undescended testicle is in the abdominal cavity, the physician will have to make an incision in the abdomen itself, adjacent to the navel. Through this incision, he will reach the testicle and bring it to the scrotum. Incidentally, there are (relatively rare) cases in which undescended testicle is discovered at older ages. In such cases, especially if the testicle is in the abdominal cavity, it will be removed from the body and not placed in the scrotum, because it will not have developed properly over the years and will not be able to function normally.

The operation itself takes between 20 minutes and one-and-a-half hours (depending on the number of procedures to be performed during the operation, and their nature). The boy will be released to his home the day after the operation at the latest. It is recommended that he not exert himself for up to one month after the operation. He will be given appointments for regular follow-up, at which the surgeon will assess the level of success of the operation.

Side Effects

After the operation, the boy may suffer from nausea and vomiting due to the anesthesia – sensations that will pass after a short time. In some cases, the testicle may move upwards towards the groin, necessitating an additional operation. Effects such as infection at the surgical site, a problem with blood supply to the testicle, damage to the vas deferens, blood clots or damage to blood vessels in the testicles are also possible but are considered to be very rare.