Undescended testis (cryptorchidism): checks, timing of surgery and outlook

The NHS explains that when a baby boy develops in the womb, the testicles grow inside the tummy and later move down into the scrotum before birth. Sometimes they do not move into the usual place, which is what undescended testicles means. Sheffield Children's NHS Foundation Trust adds that a testicle may fail to drop completely, or may drop into an abnormal position outside the scrotum, and that in some older boys a testicle starts in a normal position and then moves up.

The NHS describes the condition as common in young boys, notes that it is rare in adult men, and says it is not always known what causes it. A baby may be at higher risk if born prematurely (before the 37th week), if they have a low birth weight or if relatives have had undescended testicles. Sometimes another condition is responsible, but this is rare.

The main sign is not being able to feel two round glands inside the scrotum; you may feel one testicle, or neither. The NHS says it is usually found at the newborn physical examination in the first few days after birth. The NHS England newborn and infant physical examination (NIPE) programme includes the testes as one of four screening elements, alongside the eyes, heart and hips.

The programme's screen-positive pathway on GOV.UK describes two routes: a non-urgent referral, where the GP reviews the baby at the 6 to 8 week infant check, or an urgent referral, where a senior paediatrician reviews within 24 hours of the newborn screening. If an abnormality is confirmed, the local clinical pathway is followed.

Between checks, the NHS says the testicles will usually be looked at again at regular health visitor health and development reviews. If you think your child may have undescended testicles, or notice changes in the testicles that are not usual, see a GP.

Because many testicles descend without help, the early weeks are a period of watching. The NHS says undescended testicles often move into their usual place in the first 12 weeks. If only one testicle is affected and it has not moved into the scrotum within 4 to 5 months, a child will usually be referred to a specialist, and if both are affected referral may come sooner, usually after 8 weeks.

The specialist will examine your child and, if surgery is needed, explain what to expect; the NHS says your child's surgeon will explain what happens. The aim is to avoid a long delay for boys whose testicles have not descended.

The NHS says that if undescended testicles are not treated, they can cause your child health problems. Sheffield Children's spells out the reasoning: the testicle works best at a slightly lower temperature than the rest of the body, which is why the scrotum hangs outside it; left outside the scrotum, the testicle would not grow normally, any sperm eventually produced would be abnormal and the testicle would likely be infertile. It adds that the testicle is more likely to twist and be damaged if left in the groin.

The leaflet says that with all testicles it is important that they are in the scrotum before puberty or there is a high risk of the testicle not producing sperm properly. The NHS testicular cancer pages list having had undescended testicles as a risk factor for testicular cancer, and recommend checking your testicles regularly so you know what is normal for you; Cancer Research UK likewise lists an undescended testicle among risk factors. Specialist teams can explain what orchidopexy does and does not change about that risk.

The NHS says surgery to move the testicle to the correct place (orchidopexy) will usually be done when a child is around 1 year old and describes it as safe and effective. Sheffield Children's explains it is done under a general anaesthetic and usually involves a small cut in a skin crease in the groin and another across the scrotum. The testicle is freed up so the cord is long enough to reach the scrotum, then fixed in a pouch just under the skin. Dissolving stitches are used. In some older boys, where the testicle is not far from the scrotum, a single cut in the scrotum may be enough.

The leaflet says recovery is usually quick, especially in younger boys: the area is sore for a couple of days, most are back to normal activity within a few days, and paracetamol usually manages the pain. There is always some bruising and thickening in the scrotum, bruising settling quickly and thickening taking a few months. Older boys may need to avoid active sports, other than swimming, for 2 to 3 weeks.

According to Sheffield Children's, there is a small risk of damaging the blood supply to the testicle during the operation, in which case it may not grow or may shrink, which happens in about 1 in 50 cases. The tube that carries sperm may be damaged, though this is very uncommon. Later, scar tissue can pull the testicle back out of the scrotum and need further surgery, and a wound infection may need antibiotics.

The wounds heal very well, but the leaflet says the position and size of the testicle need to be checked 6 to 12 months after surgery in the outpatient department. Parents are asked to attend even if the child seems well. Later in life, regular self-checks of the testicles are a sensible habit.

In the NHS the path is automatic: newborn examination, GP or health visitor review, referral to paediatric surgery or urology, and surgery at around one year. The NHS says the surgery is safe and effective.

Some families choose a private paediatric surgeon for a faster appointment or date. Check that the surgeon and anaesthetist regularly treat young children, that the hospital has paediatric facilities, and that NHS follow-up with your GP or health visitor is told about the operation. Delaying referral to wait for private options is not advisable when the testicle has not descended by the NHS referral times.