Testes develop within the abdominal cavity within the embryo, and towards the end of pregnancy, they descend through a tunnel in the groin – the inguinal canal – down into the scrotum. Undescended testes are those which do not reach the scrotum, either arrested on their way down, or diverted, ending up in the groin area.
Who is Affected?
One in a hundred boys at the age of 1 year have an undescended testicle. In 10%, it affects both sides. Normally, the testicle can be felt, though occasionally it cannot – also known as an impalpable testis.
How is it Diagnosed?
On routine examination by the Paediatrician, and by the GP on subsequent occasions, testicles may be found to be undescended. Occasionally, when examined by a Paediatric Urologist, they can actually be felt, and surgery may not necessarily be required. If however they cannot be found or brought down into the scrotum, they are truly undescended and surgery would therefore be necessary.
What is the Treatment?
The majority of undescended testicles – i.e. those that can be found and palpated in the groin – are brought down by a simple day case operation called an orchidopexy. The procedure takes about 45 minutes, and involves moving the testicle into the scrotum and fixing a small hernia, which is often associated with an undescended testicle.
If the testicle cannot be felt, it primarily needs to be located. This is achieved with laparoscopy, placing a telescope into the abdomen via the belly button, and seeking out the testicle in a higher position. When located, it may be possible, usually through a 2 step laparoscopic approach, to bring the testicle down into the scrotum. If it is an abnormal testicle, or has failed to completely develop, it would be necessary to protect the remaining testicle on the other side, by performing a fixation of this testicle, within the scrotum. This prevents the possibility of twisting and/or damage, later in life.