Undescended testes

Undescended testes, also known as cryptorchidism, is a condition in which one or both testicles fail to move into the scrotum before birth. This condition is most common in premature infants but can affect full-term babies as well. The surgical procedure used to correct this condition is known as orchiopexy. Early diagnosis and timely treatment are critical to preserving fertility and reducing long-term health risks.

This comprehensive guide explores the causes, symptoms, diagnosis, and treatment of undescended testes, with a focus on the orchiopexy procedure and its global implications.

In healthy fetal development, the testes form in the abdomen and gradually descend into the scrotum during the last few months of pregnancy. In about 3% to 5% of full-term and up to 30% of premature male infants, one or both testicles do not descend properly. In most cases, the testicle will descend naturally within the first six months of life. If it doesn’t, medical intervention is required.

Understanding the type of cryptorchidism is essential for determining the right treatment:

• Palpable Undescended Testes: These can be felt during a physical exam and are typically located in the groin.
• Non-palpable Undescended Testes: These are not felt on examination and may be located in the abdomen or may be absent due to atrophy.

• Premature birth
• Low birth weight
• Hormonal imbalances during fetal development
• Genetic or environmental influences
• Family history of cryptorchidism

• Infertility: Prolonged exposure of the testes to body heat in the abdomen can impair sperm production.
• Testicular cancer: There is a significantly higher risk of developing testicular cancer in undescended testes.
• Hernia and torsion: These complications are more likely to occur with undescended testes.
• Psychological impact: Especially in adolescents, an absent or asymmetrical scrotum can cause self-esteem issues.

Parents should consult a pediatrician if one or both testicles are not present in the scrotum by six months of age. Timely referral to a pediatric urologist or surgeon ensures proper diagnosis and treatment planning.

Diagnosis begins with a thorough physical examination. If the testicle is not palpable, imaging tests may be required, such as:

• Ultrasound
• MRI
• Laparoscopy (often used as both a diagnostic and therapeutic tool)

These imaging studies help locate the testicle and determine the best course of action.

Orchiopexy is the gold standard treatment for undescended testes and is usually performed between 6 to 18 months of age. It involves moving the testicle into the scrotum and securing it in place.

Procedure Overview:

• Anesthesia: The child is placed under general anesthesia.
• Surgical access: A small incision is made in the groin or abdomen.
• Mobilization: The surgeon carefully frees the spermatic cord to allow enough length for the testicle to reach the scrotum.
• Placement: The testicle is placed in a pocket within the scrotum and stitched in position.

Laparoscopic Orchiopexy: If the testicle is located high in the abdomen or non-palpable, laparoscopic surgery is often preferred. This minimally invasive technique uses a camera and small instruments, leading to faster recovery and less postoperative pain.

• Most children go home the same day.
• Pain is managed with over-the-counter medications.
• Physical activity is restricted for a few days.
• Follow-up visits ensure proper healing and testicular function.

Orchiopexy has a success rate of over 90%, particularly when performed at the recommended age. The earlier the surgery, the better the outcomes in terms of:

• Fertility preservation
• Lower cancer risk
• Normal scrotal appearance
• Reduced psychological distress

Children who have undergone orchiopexy require long-term follow-up to monitor:

• Testicular size and development
• Signs of atrophy or recurrence
• Fertility potential in adolescence

Regular check-ups with a pediatric urologist or andrologist are recommended.

In many countries, delayed diagnosis and lack of access to pediatric surgical care remain barriers to timely orchiopexy. Global health organizations emphasize:

• Education of healthcare providers and parents
• Improved access to pediatric surgery
• Increased awareness of the consequences of untreated cryptorchidism

Efforts are ongoing to make orchiopexy more accessible worldwide, especially in low- and middle-income countries where surgical resources are limited.

• In the United States and Europe, the procedure can range from $3,000 to $10,000.
• In Asia and Latin America, the surgery is often more affordable, especially in medical tourism hubs like India, Thailand, and Mexico.
• Many countries offer government-subsidized care or coverage under national health insurance programs.

Medical travelers should research accredited hospitals, board-certified pediatric surgeons, and patient reviews to ensure safe and effective treatment abroad.

Undescended testes is a common but serious condition that requires early detection and surgical treatment to ensure long-term reproductive and general health. Orchiopexy is a safe, effective procedure with a high success rate when performed at the right time. With increasing awareness and access to pediatric surgical care worldwide, more children are receiving timely intervention and better outcomes.

If you suspect your child may have an undescended testicle, consult a pediatric specialist promptly. Early action makes all the difference.

• Q1. Is orchiopexy painful for my child?
  A: The procedure is done under general anesthesia, and most children experience only mild discomfort afterward, easily managed with pain relievers.
• Q2. Can orchiopexy prevent testicular cancer?
  A: While it doesn’t eliminate the risk, it significantly reduces it and allows for easier testicular self-examination later in life.
• Q3. Will my child be fertile after orchiopexy?
  A: Early surgery (before 1 year of age) improves the chances of normal fertility.
• Q4. What happens if the testicle cannot be found during surgery?
  A: In some cases, the testicle may be absent (vanishing testis syndrome), or severely atrophic and may be removed to prevent future complications.
• Q5. Can adults undergo orchiopexy?
  A: Yes, but the benefits are more limited. Surgery in adulthood may be done for cancer prevention or cosmetic reasons.