Undescended testicles (cryptorchidism)

In undescended testicles, the testicles are not located in the scrotum but outside of it. During pregnancy, the testicle migrates from the abdominal cavity via the inguinal canal into the scrotum, where it usually comes to rest at the time of birth. Sometimes this migration is not complete, so that the testicle remains "lying" on this path. It is possible that the testicle is still in the abdominal cavity or in the inguinal canal. After birth, it can continue to migrate downwards on its own in the first few months of life.

If this is not done, an operation should be performed at the end of the first year of life at the latest, with the testicle being moved into the scrotum. If this is not done, the testicle may suffer permanent dysfunction (reduced fertility). There is also a slightly increased risk of tumours.

An undescended testicle does not normally cause any discomfort. If pain is present, an emergency consultation should be made to rule out a torsion.

A distinction is made between different forms of undescended testicles. Primarily, undescended testicles should be distinguished from pendulous testicles. In the case of a pendulum testicle, the testicle lies in the scrotum most of the time, but can always slip back into the groin (it "swings"). This change of position does not damage the testicle and does not require surgery. There are also the following forms of undescended testicles:

• Inguinal testicles: The testicle is located in the groin and can be felt there, but cannot be moved into the scrotum.
• Sliding testicles: The testicle is located in the groin and can be moved to the scrotum for a short time, but immediately returns to the groin.
• Abdominal testicles: The testicle is still in the abdominal cavity and cannot be seen or felt from the outside.
• Secondary undescended testicles: A testicle that was initially in a normal position is suddenly no longer in the scrotum.

The diagnosis is usually made with a physical examination. Only in rare cases is an additional ultrasound scan required, e.g. to find a testicle in the abdomen.

If there are additional abnormalities in a newborn, a blood test (endocrinological clarification) is recommended.

The testicles should be in the scrotum by the time the child is twelve months old at the latest. In this way, the first six months of life can be waited for and spontaneous migration can be observed. If there is no change, surgical testicular relocation is recommended.

Some doctors are in favour of hormone therapy before surgery. The study situation regarding the benefits of such therapy is not yet standardised and there is still a lack of long-term data in this regard. We therefore only recommend hormone therapy prior to surgery in selected rare cases. The most common case is an inguinal testicle. During the operation, which is usually performed under general anaesthetic, the testicle is moved into the scrotum via a groin incision and fixed there.

If the testicle is suspected to be in the abdomen, a laparoscopy is first performed to determine whether the testicle is present and where exactly it is located. If possible, it is then moved downwards under the same anaesthetic. Sometimes two operations are necessary for this. However, it is not uncommon for no testicles to be found at all. In these cases, an additional testicular fixation of the opposite side (prophylaxis) is performed to prevent a potential twisting of the testicle.

The operation is usually performed in an outpatient setting, which means that your child can return home on the same day.

The prognosis after inguinal testicular surgery is good, the testicle can develop normally in the vast majority of cases. The complication rate for this operation is low at 1-3%.