Undescended Testis (Cryptorchidism) in Children

Expert Paediatric Surgery | Professor Mohamed Elbarbary, FRCSEd — Cairo University

Undescended testis — known medically as cryptorchidism — is one of the most common conditions Professor Mohamed Elbarbary treats. As a Cairo University Professor of Paediatric Surgery with over 36 years of experience and holder of the FRCSEd Fellowship (Royal College of Surgeons of Edinburgh, 2026), Prof. Elbarbary has performed hundreds of orchidopexies (the operation to bring the testis down) using open and laparoscopic techniques.

If your son has been found to have one or both testes that have not descended into the scrotum, this page will explain the condition clearly and help you understand the next steps.

What Is an Undescended Testis?

During fetal development, the testes form inside the abdomen and gradually descend through the inguinal canal into the scrotum, completing their journey before or shortly after birth. In undescended testis, one or both testes fail to reach their normal position in the scrotum. The testis may be located anywhere along the path of descent — in the abdomen, the inguinal canal, or just outside the scrotum — or, in some cases, may be absent (called a vanishing testis).

Undescended testis affects approximately 3–4% of full-term boys at birth, rising to about 30% in premature infants. By 3 months of age, spontaneous descent occurs in many cases, bringing the prevalence down to approximately 1%. Testes that have not descended by 6 months are very unlikely to do so spontaneously.

Why Treatment Is Important

• Fertility: The testis needs the cooler temperature of the scrotum for normal sperm production. Prolonged retention in a warmer location damages the sperm-producing cells. Surgery before 18 months significantly improves long-term fertility outcomes.

• Cancer risk: Men with a history of undescended testis have a higher risk of testicular cancer (germ cell tumour) than the general population. While the absolute risk remains low, bringing the testis to the scrotum allows it to be self-examined and monitored.

• Psychological wellbeing: A visibly empty scrotum can cause anxiety and self-consciousness as a child grows. Early correction prevents this.

• Associated conditions: Undescended testis is often associated with an inguinal hernia on the same side, which can be repaired at the same operation.

When Should Surgery Be Performed?

Current international guidelines — including those of the European Association of Urology Paediatric Urology guidelines — recommend orchidopexy (surgical fixation of the testis in the scrotum) between 6 and 18 months of age, with most specialists aiming for 12 months.

If your son is older than 18 months and has not yet been treated, surgery is still strongly recommended and should not be deferred. Every month of delay beyond the recommended window represents continued risk to fertility.

The Orchidopexy Operation

For a palpable undescended testis (felt in the groin)

A small incision is made in the groin. The testis and its blood supply are carefully mobilised to give adequate length. A small pouch is created in the scrotum and the testis is placed inside and secured with absorbable sutures. The operation takes approximately 45–60 minutes and is performed as a day case under general anaesthesia.

For an impalpable testis (cannot be felt on examination)

When the testis cannot be felt, it may be inside the abdomen (intra-abdominal), very high in the canal, or absent. Laparoscopy (keyhole surgery) is the gold standard for impalpable testes: a small camera is inserted through the navel under general anaesthesia, allowing Prof. Elbarbary to directly visualise the abdominal cavity and locate the testis. Depending on what is found:

• Testis found near the internal ring: can often be brought down in a single laparoscopic orchidopexy

• Testis high in the abdomen: a staged approach (Fowler-Stephens technique) may be used — first laparoscopy to divide the testicular vessels, followed 6 months later by the orchidopexy

• Absent testis (vanishing testis): confirmed laparoscopically; no further surgery is required, and a prosthesis can be considered at an older age if desired

Recovery After Orchidopexy

• Day case surgery — most boys go home the same day

• Mild discomfort managed with standard paediatric pain relief

• Avoid baths and strenuous activity for 2 weeks

• Follow-up at 4–6 weeks to confirm testicular position and healing

• Long-term testicular self-examination is encouraged from puberty onwards

Frequently Asked Questions

Can undescended testis cause infertility?

If left untreated or treated late, yes. The testis depends on scrotal temperature for spermatogenesis. Research consistently shows that orchidopexy performed before 18 months preserves fertility significantly better than surgery performed later. Boys with a unilateral undescended testis who are treated on time usually have normal fertility. Those with bilateral undescended testes have a greater risk of reduced fertility regardless of treatment, but early surgery maximises the chance of a good outcome.

Is the operation done with a camera (laparoscopy) or open surgery?

Both approaches are offered by Prof. Elbarbary. For a testis that can be felt (palpable), open surgery through a small groin incision is the standard approach. For a testis that cannot be felt (impalpable), laparoscopy is used first to find the testis and then to perform the repair. The approach is tailored to each child.

My son is 4 years old — is it too late for surgery?

It is never "too late" for surgery, but the outcome for fertility improves significantly with earlier treatment. If your son has not yet had surgery, we strongly recommend booking a consultation as soon as possible. Surgery at any age is better than no surgery, and the testicular cancer risk benefit of orchidopexy applies regardless of when it is performed.

Will the scar be visible?

The groin incision used for orchidopexy is small (2–3 cm) and placed in the natural skin crease, where it becomes barely visible within a few months. Laparoscopic incisions are even smaller. Long-term scarring is minimal.

drmohamedelbarbary.com | Cairo University — Kasr Al-Ainy | FRCSEd 2026