When the nurse at the hospital noticed that Courtney Dauphinee’s newborn son had an undescended testicle—that is, he had only one “ball” in his scrotum, not two—the Ottawa mom was pretty freaked out. “I didn’t even want to look at it,” she admits.
Dauphinee need not have worried—by the time her son was checked out by his paediatrician at one week of age, his testicle had descended into its rightful place, without any intervention. They got lucky; more often than not, a baby in this situation would eventually require undescended testicle surgery.
When a baby boy is growing in his mom’s uterus, his testicles form in his abdomen. In the last two months of pregnancy, the testicles make their way down to the scrotum. But in three percent of boys, one (or less commonly, both) testicle hasn’t finished its trip by the time of birth. The chances of a premature baby’s testicle not having fully descended by birth is much higher, at 30 percent.
Doctors and midwives routinely check for an undescended testicle (also called cryptorchidism) at a baby’s newborn exam. If they find one, they will usually refer you to a specialist.
The specialist—typically a paediatric urologist—might take a wait-and-see approach. That’s because the undescended testicle will often make its way to the proper spot on its own by four to six months, says Walid A. Farhat, a paediatric urologist at Toronto’s Hospital for Sick Children. Your doctor might, however, order an ultrasound, CT or MRI to determine the exact location of the testicle. These tests aren’t actually necessary, however (read on to find out why).
If your son’s testicle hasn’t come down by four to six months, it’s unlikely it will do so on its own. “Those are the boys that we’re looking at surgical correction for,” says Peter Anderson, a paediatric urologist at IWK Health Centre in Halifax.
The idea of your baby or toddler having surgery can be upsetting and even terrifying—but it’s important to bring the testicle down. For one, the boy’s future fertility could depend on it. A testicle that is up in the body as opposed to in the scrotum will be too hot, says Farhat, so sperm will not be able to develop properly. On top of that, undescended testicles have a slight increase in cancer risk—and while surgically bringing the testicle down might not necessarily negate the risk, it does make it possible to check the testicle for lumps. Anderson stresses that the increased cancer risk is small, and only applies to the testicles that are being brought down from the abdomen, as opposed to the groin area.
The ideal age for surgery is between six and 18 months. “We don’t like to wait too long past a year or a year and a half because the longer the testicle is not in the right environment it starts limiting its fertility ability,” says Farhat. He notes that the risk of fertility issues is minimal if the undescended testicle is repaired before age two.
The surgery is relatively quick—from one to two hours, depending on the location of the testicle. (In some cases where the testicle is in the abdomen, a two-part procedure might be necessary.) The surgery is typically uncomplicated, involving one or two small incisions in the groin or scrotum. In cases where the testicle is higher, laparoscopy might be used.
Recovery is generally swift. Within a day or two, most kids will be back to normal activities, and will not be crying or showing other signs of pain. “Eighty to ninety percent of the kids will recover so fast, they won’t even know they had surgery,” says Farhat, who notes that generally, the younger the child, the easier the recovery.
That said, expect some pretty severe swelling afterwards. “The swelling and bruising is at its worst 48 to 72 hours after surgery,” says Megan Saunders, a registered nurse at Toronto’s Hospital for Sick Children. She says she gets lots of calls from panicky parents. “It can go from looking OK to looking pretty alarming quite suddenly,” she says. She adds that anything from golf ball- to even tennis ball-sized swelling is normal (seriously!) and not a sign of complication or that the child is in pain. The swelling can last up to six weeks.
Burlington, Ont. mom Nancy Coleman* and her husband were nervous when their third child’s testicle still wasn’t down at age one and he needed surgery. “Sending our little one off with a doctor and nurses was so scary for me and my husband,” she says. But the surgery was quick—it was over and done with in the span of an hour—and his recovery was equally speedy. “He did experience a bit of pain after the procedure, but the next day he was walking around and playing, just more cautiously than normal,” she says. And although going through surgery was stressful on her family, they’re glad they did it. “We wanted to ensure there would be no issues for him later in life,” says Coleman. (Here's some advice for getting through your child's day surgery.)
Some parents report that their son’s doctor couldn’t feel both testicles at the newborn exam, but they were able to feel them at home, perhaps in the bath or during a diaper change. In that case, it may be that the baby in fact had what’s called a retractile testicle. This is when the testicle moves back and forth between the scrotum and groin. For most kids, the testicle will move to its proper location and stay there permanently before or during puberty, with no intervention.
Before you see a specialist, your baby’s doctor may send you for an ultrasound, CT scan or MRI to locate the position of the testicle. This is an outdated practice, says Farhat, because it doesn’t provide useful information. Anderson agrees. “[These] tend to make no difference to the management plan,” he says.
Here’s why: If the testicle is in the groin, a surgeon can press down on the groin and feel it, so the location is known. Otherwise, the testicle is in the abdomen (or absent, which is sometimes the case). But a baby or toddler’s testicles are small, and imaging technology isn’t precise enough say for certain that what is showing up in the scan is definitively an undescended testicle. So surgery will still be needed to locate the testicle—and then it’s moved at that time as well. If your doctor recommends imaging, Farhat suggests asking your doctor what the testing will accomplish.
*Name has been changed
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