Patient information · Paediatrics
Undescended testicle
timing changes the outcome
An undescended testicle has not moved down into the scrotum. It affects around one in twenty boys at birth and most descend on their own in the first few months. Those that do not need surgery, and the age at which that happens genuinely affects fertility later — which is why referral should not be delayed.
Call 999 or go to an emergency department if there is
- sudden severe pain in the groin or abdomen in a boy with an undescended testicle
- a painful, tender lump in the groin, with vomiting
- a scrotum or groin that is red, swollen and exquisitely tender
- both testicles undescended in a newborn, with any ambiguity of the genitalia — this needs urgent assessment
- a testicle that was previously descended and has disappeared with pain
An undescended testicle is at higher risk of torsion, and torsion presents as sudden severe pain requiring surgery within hours. Bilateral undescended testes in a newborn require urgent endocrine and genetic assessment.
Undescended or retractile?
- Retractile — the testicle can be gently brought down into the scrotum and stays there for a moment. This is normal, caused by an active reflex pulling it up, and needs no surgery — only annual checks, because a small proportion ascend later.
- Undescended — cannot be brought into the scrotum, or springs straight back up.
- Ascending — was previously in the scrotum and has moved up as the child grew. This is recognised and does need treating.
- Examine your son in a warm room with warm hands, or in a warm bath — cold makes every testicle retract and is the commonest cause of confusion.
The timeline
Why the timing matters
The testicle needs to be cooler than body temperature to produce sperm normally. Left in the groin or abdomen, the cells that will eventually make sperm deteriorate progressively, and that damage begins in the first year. Surgery between six and eighteen months gives the best fertility outcomes; performed later, the benefit falls. Referral is therefore recommended by three to six months and should not be deferred to 'see if it comes down' beyond that point.
Surgery
- Orchidopexy — the testicle is brought down and fixed in the scrotum, usually as a day case under general anaesthetic.
- Where the testicle cannot be felt, a laparoscopy locates it first; occasionally it is absent or has withered before birth.
- Recovery is quick — most boys are back to normal within a week, avoiding straddle toys and rough play for two to four weeks.
- Hormone treatment is not recommended as an alternative to surgery.
Fertility and cancer
- Fertility — with one undescended testicle corrected in good time, fertility is usually normal or near-normal. With both affected, fertility is more often reduced, though many men still father children.
- Cancer — there is a modestly increased lifetime risk of testicular cancer, which surgery reduces but does not eliminate. It also makes the testicle examinable, which matters for early detection.
- Teach self-examination in adolescence. Any boy who has had this should know how to check monthly and what a lump feels like — this is the single most useful long-term thing you can do.
What to check as he grows
- Check both testicles are in the scrotum at routine appointments and during bath time.
- An ascending testicle can occur up to around age ten, so a testicle that was previously down should still be checked.
- Report any new lump, swelling or pain promptly.
- Retractile testicles need an annual check until puberty.
Why come to us. The commonest problem here is delay — being told to wait and see well past the point where waiting costs something. We see children seven days a week, examine properly in a warm room with time, distinguish retractile from genuinely undescended, perform ultrasound on site where useful, and refer to paediatric surgery promptly when it is needed rather than at the next review. Appointments are available at weekends and after school.
Examined properly, referred promptly if needed
Paediatrics seven days a week, ultrasound on site.
Tower Bridge Hospital London
97–99 Whitechapel Road, London E1 1DT
WhatsApp 07903 284 189
info@mhwclinic.co.uk
Open Mon–Sat, 9am–7pm (closed Sundays until September)
In an emergency
Call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
When we are closed and it is not an emergency
Call NHS 111 or visit 111.nhs.uk.