Undescended Testicle in Babies

When to get help

Go to an emergency department or call emergency services — 999 in the UK, 112 or 999 in Ireland and across the EU, 911 in the US and Canada, 000 in Australia, 111 in New Zealand — if your baby has a sudden painful, red or swollen scrotum, or a firm tender lump in the groin with vomiting or inconsolable crying. That is not undescended testicles; it is a picture that includes testicular torsion and a trapped hernia, both of which are time-critical.

See a GP or paediatrician, without urgency but without postponing it, if:

• You cannot feel one or both testicles in the scrotum at your baby's routine reviews.
• A testicle you used to be able to feel is no longer there, or has moved up.
• One side of the scrotum looks flat or underdeveloped compared with the other.
• Your baby is approaching four to five months and a testicle still has not appeared.

The timeline the NHS works to

The NHS is specific about the schedule, and knowing it saves a lot of anxious waiting.

Undescended testicles often move into their usual place in the scrotum in the first 12 weeks after birth, and during that time the testicles are checked at routine health and development reviews. If only one testicle is affected and it has not moved into the scrotum within four to five months, the usual step is a referral to a specialist. If both testicles are affected, referral is usually made sooner, often after about eight weeks.

Where surgery is needed, the operation to bring the testicle into the scrotum is called an orchidopexy, and the NHS says it is usually done at around one year old. It is described as safe and effective, and the surgeon will explain what to expect.

Why it is treated rather than left

The testicle develops inside the abdomen and normally travels down into the scrotum before birth. The scrotum sits outside the body because sperm production works better at a slightly lower temperature, so a testicle left in the wrong place is in a warmer environment than it is built for.

The NHS is direct about the consequences: if undescended testicles are not treated, they can cause health problems. Those include effects on fertility later in life and a higher risk of testicular problems in adulthood, and a testicle sitting in the scrotum is also much easier to examine as an adult. Bringing it down early is what reduces those risks, which is why the timeline is not open-ended.

Retractile testes: the common false alarm

Many parents who cannot feel a testicle have a retractile one. A strong reflex pulls the testicle up towards the groin when a baby is cold, being handled, or upset, and it drops back down when they are warm and relaxed.

The test is the setting. Check during or just after a warm bath, with your baby calm and lying back, with warm hands. If the testicle can be felt and gently coaxed into the scrotum and stays there for a moment, it is retractile rather than undescended. Retractile testes usually settle by themselves as a child grows, but they are still worth mentioning so they can be followed, because a small number end up needing treatment.

Do not squeeze or tug. A quick, warm, gentle feel is the whole examination.

Who is more likely to be affected

The NHS lists babies born prematurely, before 37 weeks, babies with a low birth weight, and babies who have relatives with a history of undescended testicles as being at higher risk. Descent commonly finishes in the last weeks of pregnancy, which is why prematurity is such a strong factor, and it also explains why a premature baby's testicles may come down in their own time after birth.

Occasionally an undescended testicle is part of another condition, but the NHS notes this is rare.

What happens at the specialist appointment

Expect a careful examination in a warm room, with your baby relaxed, to work out whether the testicle can be felt in the groin or not at all. If it can be felt, the plan is usually a straightforward orchidopexy. If neither testicle can be felt, further assessment is arranged, which may include keyhole surgery to locate it.

Scans are less useful here than parents expect, because an ultrasound often cannot find a testicle that an experienced pair of hands cannot feel, and a normal scan does not change the plan. Do not be surprised if one is not offered.

The operation and afterwards

Orchidopexy is usually a day case under general anaesthetic, with two small incisions: one in the groin and one in the scrotum. The testicle is freed and stitched into place in the scrotum.

Recovery is generally quick. Expect swelling and bruising for a week or two, loose clothing and frequent nappy changes to keep the area clean, and a review to confirm the testicle has stayed where it should. Follow-up over the following year checks that it is growing normally.

What to check at home afterwards

Once your child is old enough, the habit of checking is worth building, because a history of undescended testicles carries a slightly raised risk of problems later. In babyhood, all you need to do is notice at nappy changes whether both testicles are where they should be, and mention it at reviews if one seems to have gone missing again. A testicle that ascends after having been down does happen, and it is treated in exactly the same way.