Undescended Testis & Retractile Testis Treatment in Children
Dr. Yaman Al-Tal Best Urologist in Jordan, Urologist at Al-Abdali Hospital
Undescended Testis & Retractile Testis
Dr. Yaman Al Tal — Best urologist in Jordan, urologist at Al Abdali Hospital
When one or both testicles do not descend into the scrotum at the normal time after birth, this is known as an “undescended testis.” This condition requires specialist follow-up, because early intervention improves future reproductive health and reduces long-term risks.
What is an undescended testis?
As the fetus grows month by month in the mother’s womb, the two testicles initially form inside the abdomen. In the last third of pregnancy, they normally travel through a small opening in the abdominal wall, passing through the inguinal canal (a passage between the thigh and the scrotum), until they reach their normal position inside the scrotum beneath the penis. After that, the opening in the abdominal wall usually closes on its own. (If it does not close fully, this may later develop into an inguinal hernia.)
Undescended testis is a common condition in children. It occurs in about 3 out of every 100 babies born at full term, and the rate increases to about 30 out of every 100 babies born prematurely. Most often, only one testicle fails to descend. In a smaller percentage (about 10%), both testicles fail to descend.
It is usually detected during the baby’s medical examination after birth. Most commonly, the testicle is in the inguinal canal, and in some cases it may be inside the abdomen. In such cases, the doctor often recommends waiting until the baby is 4–6 months old with regular follow-up, because the testicle may descend naturally as the child grows during that period.
Dr. Yaman Altal
Consultant urologic and kidney surgeon in Jordan. Consultant in endoscopic and robotic surgery for kidney, prostate, and bladder tumors.
- 14 years of experience in the United Kingdom.
- Subspecialty training at Imperial College London University Hospital in prostate surgery, robotics, and endoscopy.
The difference between an undescended testis and a retractile testis in children
A retractile testis is another common condition in children. It usually happens due to overactivity of the cremaster muscle (the muscle that lifts the testicle). When this muscle contracts—sometimes as a reflex from touch, laughing, fear, or temperature changes—it can pull the testicle upward toward the body (either toward the inguinal canal or into the abdomen).
A retractile testis moves easily in and out of the scrotum, rather than staying there all the time, and it usually does not cause pain or discomfort to the child.
This differs from an undescended testis: the retractile testis has descended into the scrotum but is not stable in place, while the undescended testis failed to descend into the scrotum. A retractile testis often resolves on its own during puberty as the testicle grows and becomes more stable within the scrotum.
In rare cases, the retractile testis can remain in the groin (in the inguinal canal) and cannot be pulled down into the scrotum—this is called an ascending testis, and it requires medical intervention.
Diagnosing an undescended testis in children
After the doctor examines the child clinically and confirms that one or both testicles are not in the scrotum, the following tests may be used to help determine the location of the undescended testicle:
X-ray imaging.
Ultrasound imaging.
MRI imaging, after injecting the child with contrast (dye) to confirm the presence of the testicle and pinpoint its location.
Causes of an undescended testis in children
The main cause is not clearly known, but several factors may increase a child’s risk, including:
Premature birth before 37 weeks of pregnancy.
Low birth weight.
Family history (close relatives with testicular conditions).
Maternal smoking.
Down syndrome, which can interfere with normal fetal development during pregnancy.
Treatment of an undescended testis in children
Treatment is considered if the testicle does not descend naturally by 6 months of age. Surgical correction and returning the testicle to its position is recommended before 12 months of age to reduce the risk of testicular cancer and fertility effects later on (the testicle produces sperm and the male hormone testosterone, and it functions best inside the scrotum because the temperature is lower than core body temperature).
Hormonal treatment
This involves injecting hormones that stimulate testosterone release and help promote testicular descent, using human chorionic gonadotropin (HCG) injections.
Surgical treatment
The doctor may perform orchiopexy via open surgery, which is an older approach that requires a larger abdominal incision to locate the testicle and fix it in the scrotum. If the testicle is in the inguinal canal, an incision is made in the groin (thigh crease) and another in the scrotum to bring it down and secure it.
Laparoscopy
A minimally invasive procedure that requires a small abdominal incision to insert a thin tube with a camera and light to examine the abdomen and locate the testicle. It can be used for diagnosis or treatment—meaning the issue can be corrected and the testicle returned to the scrotum in the same procedure. This is done under anesthesia, takes about one hour, and the child can usually go home the same day.
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FAQ about undescended testis
When should orchiopexy be performed?
It is preferable to perform the procedure between 6 and 18 months of age, because early intervention helps preserve normal fertility and reduces the risk of future tumors or torsion.
Is the operation dangerous or painful?
Orchiopexy is a safe, simple procedure. It is usually performed under general anesthesia and takes about one hour. The child can go home the same day and typically feels comfortable within a few days.
What are the risks if an undescended testicle is not treated?
Delaying treatment can lead to reduced sperm production later, increased risk of testicular cancer or testicular torsion, and changes in scrotal appearance—or even loss of the testicle.
Can it affect fertility or sexual development?
Yes. If the testicle remains in the abdomen for a long time without treatment, its function may be affected, which can reduce fertility or delay sexual development later on.
Can the testicle move up again after surgery?
In very rare cases, the testicle may ascend again after surgery. That’s why the child is followed up periodically after the operation to ensure the testicle remains in its normal position.