A CONGENITAL CONDITION
Undescended testicle in children
A condition in which one or both testicles are not stably present in the scrotum.
Undescended testicle
An undescended testicle, or cryptorchidism, is a condition in which one or both testicles are not stably present in the scrotum.
During development, the testicles form in the abdomen and normally descend progressively into the scrotum. When this descent is not completed, the testicle may stop along its pathway, for example in the groin, or may be non-palpable.
An undescended testicle may affect one side or both sides and requires a specialist assessment to define the position of the testicle and the most appropriate pathway.
Symptoms and signs to look out for
The main sign is the absence of one or both testicles from the scrotum, noticed by parents during hygiene routines or by the paediatrician during a check-up.
In general, an undescended testicle does not cause pain. For this reason, it may be found incidentally during routine paediatric checks.
It is useful to pay attention if
Causes or associated factors
An undescended testicle is linked to the failure or incomplete descent of the testicle into the scrotum.
In some children, the testicle may complete its descent spontaneously during the first months of life. After 6 months, however, spontaneous descent becomes much less likely: for this reason, if there is any doubt, a specialist assessment is important.
A true undescended testicle must be distinguished from a retractile testicle, which may temporarily move upwards due to the cremasteric reflex but can be brought back into the scrotum during the examination. This distinction requires medical assessment.
When to book a consultation
A consultation is always indicated if there is any doubt.
It is advisable to see a paediatric surgeon when one or both testicles are not present in the scrotum, when the paediatrician suspects an undescended testicle or when parents notice that the position of the testicle is variable or uncertain.
The assessment is important because an undescended testicle must be monitored and, when indicated, treated within the correct timeframe.
Assessment and diagnosis
Diagnosis is mainly made through a specialist consultation.
During the physical examination, the paediatric surgeon assesses whether the testicle is palpable, where it is located and whether it can be brought into the scrotum. In doubtful cases, an ultrasound scan may be requested to further assess the position of the testicle or clarify the clinical picture.
At the end of the assessment, the most appropriate pathway is discussed with the family: observation, follow-up over time or surgical indication.
How it is treated
Treatment depends on the child’s age, the position of the testicle and the specialist assessment.
After 6 months, if the testicle has not descended into the scrotum, spontaneous descent becomes very unlikely. From this age, surgery should therefore be considered, although, when possible, it is preferable to schedule it around 12 months.
The surgical treatment is called orchidopexy and aims to bring the testicle into the scrotum and fix it in the correct position.
When surgery is needed and what it involves
When the testicle does not descend spontaneously, orchidopexy is indicated.
The procedure consists of mobilising the testicle and fixing it in the scrotum. It may be performed using an:
- inguinal approach;
- scrotal approach;
- laparoscopic approach, in cases where the testicle is located inside the abdomen.
The choice of technique depends on the position of the testicle, the child’s age and the paediatric surgeon’s assessment.
Depending on the child’s age, the procedure may involve different admission arrangements: over one year of age, it may be performed as day surgery, while under 12 months, inpatient admission may be indicated.
As with any surgical procedure, orchidopexy may involve some risks or technical difficulties, which are discussed with the family before surgery. In some cases, for example, short testicular vessels may make it difficult to bring the testicle into the scrotum. During surgery, anatomical variations not evident beforehand may also be found, such as dissociation between the testis and epididymis.
Possible complications, although uncommon, include injury to the testicle or vas deferens and the possibility of recurrence.
Recovery and useful instructions
After surgery, recovery requires some precautions.
In general, Dr Rapuzzi’s instructions include:
Follow-up is used to check post-operative recovery and assess testicular growth over time. Any further follow-up checks are defined by the specialist based on the individual case.
Parents’ most common questions
A consultation is always indicated if there is any doubt, especially if one or both testicles are not stably present in the scrotum or if the paediatrician suspects an undescended testicle.
Not always. The main assessment is the clinical examination. An ultrasound scan may be requested in doubtful cases or when it is necessary to further assess the position of the testicle.
If the testicle has not descended after 6 months, surgery may be considered. According to Dr Rapuzzi’s indication, surgery may be performed from 6 months of age, but it is often preferable after 12 months, unless there are specific circumstances.
The procedure, called orchidopexy, consists of bringing the testicle into the scrotum and fixing it in the correct position. It may be performed using an inguinoscrotal, scrotal or laparoscopic technique, depending on the case.
Correction within the appropriate timeframe is important to support proper testicular development, make future monitoring easier and reduce possible long-term consequences. The most appropriate pathway should always be defined with the specialist.
Yes, like any surgical procedure. In some cases, short testicular vessels may make it more complex to bring the testicle into the scrotum. Anatomical variations not evident before surgery may also be found. The surgeon explains benefits, limits and possible risks to the family before the procedure.
Note: the information on this website is provided for guidance only and does not replace a specialist medical assessment. In case of acute symptoms, significant pain or a worsening general condition, you should contact a doctor or go to the emergency department.
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