Treating undescended testicles

Undescended testicles will usually move down into the scrotum naturally by the time your child is three to six months old.

If the testicles don't descend by six months, it's very unlikely they will do so without treatment, so a surgical procedure to reposition one or both testicles will normally be recommended. This procedure is called an orchidopexy.

The operation should ideally be carried out before your child is 12 months old. This is because waiting longer than this may increase a boy's risk of developing fertility problems or Testicular cancer later in life.

Orchidopexy

In most cases, if the testicle can be felt in the groin, a simple orchidopexy can be performed. This 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 through a second incision.

If the testicle is thought to be higher in the abdomen (tummy), a type of keyhole surgery known as a laparoscopy is sometimes carried out to locate it before it's repositioned. This involves passing a laparoscope (a small tube containing a light source and a camera) through a small incision in your child's abdomen.

A testicle found inside the abdomen can occasionally be brought down to the scrotum in a single operation, but sometimes this has to be done in two separate stages.

In cases where the testicle is impalpable (in the abdomen), theres a small possibility that theres no testicle at all on that side, either due to it not having developed properly or it having twisted and withered away early in life. This would be confirmed during the laparoscopy.

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

Orchidopexies and laparoscopies are performed under a general anaesthetic , which means your child will be asleep during the procedure and won't feel any pain while it's carried out.

The operation normally 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 as a result of the anaesthetic. This is nothing to worry about.

The following advice should help to speed up your childs recovery time and reduce their risk ofdeveloping any 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 childs groin area may feel sore for a while after the operation. Wearing loose-fitting clothing will help, although wearing a nappy is fine and can help protect the area.
• Follow your surgeons 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 moving 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 38C (100.4F) or above
• the site of the surgery being red, inflamed or feeling hotter than the surrounding area
• adischarge of fluid or pus 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 originally, the more likely surgery will be successful.

The success rate for treating palpable testicles (located near the scrotum) is estimated to be higher than 90%. The operation is slightly less successful in treating impalpable testicles (located in the abdomen).

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 semen to pass through

In general, complication rates are low. The main risk is atrophy (loss) of the testicle, and the chances of this increase the further the testicle has to be moved to get to the scrotum.