My son's testicle has not come down — what does this mean?

मेरे बेटे का अंडकोष नहीं उतरा — इसका क्या मतलब है?

You have just been told that your baby boy has an undescended testicle. The doctor used a word — orchidopexy — and now you are at home, anxious, searching the internet, and finding things that range from reassuring to alarming.

Here is a straightforward, factual explanation — written for parents, not for medical exams.

हिन्दी में पढ़ें: नीचे इस पूरे लेख का हिंदी अनुवाद है।

What is an undescended testicle?

During pregnancy, a baby boy’s testes develop inside the abdomen. In the final weeks before birth, they travel down through the groin and into the scrotum — the small pouch of skin you can see and feel between the legs.

In about 1 in 25 full-term baby boys, one testis (and occasionally both) does not complete this journey. This is called an undescended testis (also called cryptorchidism).

It is more common in premature babies — in some, both testes may not have descended at birth.

Will it come down on its own?

Sometimes. About half of undescended testes that are present at birth will descend on their own in the first 3–6 months of life, usually without any treatment.

After 6 months of age, spontaneous descent becomes very unlikely. If the testicle has not come down by around 6 months (or by the time of the first birthday), it will almost certainly need surgery.

The recommendation from all major paediatric urology guidelines, including those used in India, is that surgery should be done between 6 and 18 months of age — ideally before the first birthday.

Why does it matter? Why not just leave it?

This is the most important question parents ask. Here is the honest answer:

1. Fertility. The testicle needs to sit in the scrotum because the scrotum is cooler than the body — and sperm production requires this lower temperature. A testicle left undescended for years will not develop properly. Early surgery significantly reduces (but does not eliminate) the risk of reduced fertility.

2. Cancer risk. An undescended testicle has a higher lifetime risk of developing testicular cancer. Bringing it down into the scrotum where it can be examined regularly reduces this risk and allows early detection.

3. Torsion. An undescended testicle is more prone to twisting (testicular torsion), which is a painful emergency requiring immediate surgery.

4. Hernia. Most boys with an undescended testicle also have an inguinal hernia on the same side, which is repaired at the same time during orchidopexy.

What is the operation?

The operation is called an orchidopexy — from the Greek for “testis” and “fixation.”

Through a small cut in the groin (and usually a second small cut in the scrotum), the surgeon brings the testicle down into the scrotum and fixes it there with dissolving stitches. The hernia, if present, is repaired at the same time.

It is done under general anaesthesia. In most cases it takes about 45–60 minutes and your son goes home the same day.

What if the testicle cannot be felt?

In about 20% of cases, the testicle is impalpable — the doctor cannot feel it on examination. This means it may be:

• High up in the groin or abdomen
• A very small (atrophic) testicle
• Absent (a condition called monorchidism, where only one testicle developed)

For an impalpable testicle, we use diagnostic laparoscopy — a keyhole camera under anaesthesia — to look inside and find the testicle before deciding the best approach. If found in the abdomen, the operation may be done in two stages.

When should I bring my son?

If your son is under 6 months — there is time, but arrange a review now so we can monitor whether descent occurs.

If your son is 6–18 months and the testicle has not descended — book a surgical consultation. The sooner surgery is done in this window, the better the outcome.

If your son is older and has not yet had surgery — do not delay further. Surgery can still be done and is still worthwhile.

हिन्दी में — बिना उतरा अंडकोष

यह क्या है?

गर्भावस्था में लड़के के अंडकोष पेट के अंदर बनते हैं। जन्म से पहले ये नीचे उतरकर अंडकोष की थैली में आ जाते हैं। लगभग 25 में से 1 बच्चे में एक या दोनों अंडकोष थैली में नहीं उतरते।

क्या यह खुद ठीक हो सकता है?

6 महीने की उम्र तक लगभग आधे मामलों में अंडकोष खुद उतर जाता है। लेकिन 6 महीने के बाद खुद उतरने की संभावना बहुत कम होती है।

ऑपरेशन कब करवाएं?

6 से 18 महीने की उम्र के बीच — आदर्श रूप से पहले जन्मदिन से पहले। जितनी जल्दी, उतना बेहतर।

क्यों ज़रूरी है?

• भविष्य में संतान-क्षमता की रक्षा के लिए
• अंडकोष के कैंसर का जोखिम कम करने के लिए
• मुड़ने (टॉर्शन) के खतरे से बचाने के लिए
• साथ में हर्निया भी ठीक किया जाता है

ऑपरेशन कैसा होता है?

ऑर्किडोपेक्सी — एक छोटा ऑपरेशन जिसमें अंडकोष को थैली में लाकर स्थिर किया जाता है। बेहोशी की दवा के साथ किया जाता है और बच्चा उसी दिन घर जाता है।

आरिया हेल्थकेयर में — डॉ. सौरव सुल्तानिया ऑर्किडोपेक्सी करते हैं, जिसमें न महसूस होने वाले अंडकोष के लिए लेप्रोस्कोपी भी शामिल है।

Dr. Saurav Sultania is a Paediatric & Neonatal Surgeon (MCh, SMS Jaipur) and the first paediatric surgeon of Santhal Pargana.