Complications of Undescended Testis Surgery in Children: What Parents Need to Know 2026

Making the decision to have your child undergo any operation is never easy. If your son has been diagnosed with an undescended testis and surgery has been recommended, you may be wondering about the risks. Professor Mohamed Elbarbary, pediatric surgery specialist at Cairo University’s Kasr Al-Ainy Medical School and Fellow of the Royal College of Surgeons of Edinburgh (FRCSEd), gives parents a clear, honest picture of the complications of undescended testis surgery and what to expect.

What Is Undescended Testis and Why Does Surgery Matter?

Undescended testis (cryptorchidism) occurs when one or both testicles fail to descend from the abdomen into the scrotum before birth or within the first few months of life. It affects approximately 3% of full-term male newborns and is more common in premature infants.

Surgery — orchidopexy — is required in virtually all cases. The testis needs to be in the scrotum, where it is 1-2°C cooler than body temperature, for normal development. Left in the abdomen or inguinal canal, testicular tissue is gradually damaged by the higher temperature. Consequences of delayed or absent treatment include impaired fertility, increased risk of testicular torsion, and a 3-5 times higher lifetime risk of testicular cancer. This is why orchidopexy is recommended before 18 months of age — ideally between 6 and 12 months.

Possible Complications of Undescended Testis Surgery

Injury to the vas deferens: The vas deferens is the tube that carries sperm from the testis. In experienced pediatric surgical hands this risk is less than 0.5%. Bilateral damage to the vas deferens would affect fertility.

Injury to the testicular blood vessels (testicular atrophy): The testicular artery must be carefully preserved. If damaged or overstretched, the testis may shrink and lose function over time. For a testis in the inguinal canal, the risk is very low (under 1%); for a high abdominal testis requiring staged surgery, it is somewhat higher.

Wound infection: A small risk of infection (around 1-2%), treated with antibiotics and resolving fully in most cases.

Testis ascending (re-ascent): After orchidopexy, approximately 1-2% of testes migrate back upward over time. Regular follow-up examinations detect this early.

When Is Surgery Necessary?

Surgery is recommended for all true undescended testes — there is no effective non-surgical alternative. Hormone injections (hCG or GnRH) are occasionally tried but have low success rates (less than 20%) and are not a substitute for surgery.

The ideal timing is between 6 and 12 months of age, and no later than 18 months. The testicular tissue has not yet suffered irreversible damage, and the blood vessels and structures are more pliable. Early surgery is associated with better fertility outcomes and lower cancer risk.

How Is the Operation Performed?

Professor Elbarbary, with over 36 years of experience at Cairo University, tailors the surgical approach to each child’s anatomy.

Standard orchidopexy: Under general anaesthesia, a small incision is made in the groin. The testis and its blood vessels are carefully freed from surrounding tissue. The vas deferens is identified and protected at every step. The testis is then guided into the scrotum and secured in a specially created pouch beneath the scrotal skin. Dissolving stitches close the wound. The procedure takes 30-60 minutes.

Laparoscopic orchidopexy: For testes located high in the abdomen, a laparoscope is inserted through the navel. High abdominal testes may require a staged procedure (Fowler-Stephens technique) in which the testicular vessels are divided in a first operation, followed by orchidopexy 3-6 months later. Most children go home the same day or the morning after surgery.

Life After the Operation

Mild scrotal or groin discomfort lasts 2-3 days, managed with children’s paracetamol or ibuprofen. Some swelling and bruising of the scrotum is expected — it usually resolves within 1-2 weeks. Gentle activity resumes within a few days; avoid rough play, bicycle riding, and swimming for 3 weeks. Dissolving stitches — keep the area dry for 5-7 days. An examination 4-6 weeks after surgery confirms the testis is in the correct position. Annual examinations until puberty are recommended, and monthly self-examination after puberty is advised.

Frequently Asked Questions

Will the operation affect my son’s ability to have children in the future?
When orchidopexy is performed before 18 months of age by an experienced surgeon, most boys with unilateral undescended testis have normal fertility as adults. For bilateral undescended testes, fertility outcomes depend on how high the testes were located and how early surgery was performed.

Is it more dangerous to wait until my son is older for surgery?
Yes. Every month of delay beyond 12-18 months increases the risk of permanent damage to testicular tissue. The “let’s wait until he’s stronger” approach is outdated — orchidopexy is safe even in infants, and early surgery gives the best long-term results.

Does having undescended testis mean my son will definitely get testicular cancer?
No. The absolute lifetime risk of testicular cancer in men with a history of undescended testis is approximately 1-2%. Early orchidopexy further reduces this risk and ensures the testis is in the scrotum where any changes can be detected early by self-examination.

What should I watch for after surgery that would require an urgent call to the doctor?
Contact your surgeon immediately if you notice: high fever (above 38.5°C), severe worsening pain not controlled by pain relief, significant bleeding from the wound, the scrotum becoming very swollen and hard, or any sign that the testis has disappeared from the scrotum.

Book a Consultation with Professor Mohamed Elbarbary

If your son has been diagnosed with undescended testis, time matters. Early surgery by a specialist with specific pediatric surgical expertise gives your son the best chance of a healthy future.

Professor Mohamed Elbarbary, FRCSEd, is a pediatric surgery consultant at Cairo University with over 36 years of specialized experience. He sees patients at his clinic in Sheikh Zayed (City Clinic, Gezira Plaza) and at Kasr Al-Ainy Medical School. To book an appointment, contact us through the website or call the clinic directly.