Undescended testes (UDT) are common, with about 4% of boys having one or both testes absent from the scrotum at birth. Descent may occur in the first few months with the incidence falling to about 1% by the age of a year. It is now thought that if descent is going to occur postnatally this will have happened by 3 months so continued observation beyond that time is not necessary and we would now suggest that any boy in whom the testes are absent from the scrotum at birth or at the 6 weeks check can simply be referred at that time rather than waiting or if observed in primary care, that referral is not delayed more than 3 months. Approximately 80% of UDT are palpable in the groin or a potential ectopic position, 20% of UDT are not easily palpable. If your examination reveals an impalpable testis this is helpful information to include in the referral.
Orchidopexy, the procedure to place the testis in the scrotum, may now be considered for boys as young as 6 months, although the majority of procedures are performed after this time but as close to 12 months of age as feasible.
The cremaster reflex starts to become active at 8 months to a year and testes that were previously present in the scrotum may start to retract. For a diagnosis of retractile testis, it should be possible to bring the testis fully into the scrotum or to observe it in the scrotum at least intermittently. It is not thought that retractile testes come to any harm as a consequence of being in the groin some of the time. In almost all boys retractile testes will have dropped permanently into the scrotum by puberty and it is not normally necessary to consider surgery.
In a few boys it becomes clear that a testis is not in the scrotum in later childhood, having clearly been in the scrotum in infancy. It does seem that the testis can ascend in such cases and orchidopexy may be required as for an undescended testis diagnosed at an older age.
For boys who are suspected to have bilateral undescended testes we would expect these boys to be referred to us after their initial post-natal baby check. However, if this is first identified at the 6 week in primary care then we would invite immediate referral for these boys.
FM, LS, JB Sept 22
Who to refer:
- Boys with testes absent from the scrotum at newborn or 6 week check or in whom the testis has not descended by 3 months of age.
- Older boys in whom the testis are absent from the scrotum and cannot confidently be brought to the scrotum.
- All boys with suspected bilateral undescended testes.
Who not to refer:
- Boys in whom a diagnosis of retractile testes can be made confidently.
How to refer:
- Please refer via SCI gateway
Referral priority
- Boys with undescended testes will generally be triaged as routine.
- Boys with bilateral undescended testes will be triaged more urgently
Surgical priority
- Orchidopexy is generally a non urgent procedure.
Simple reassurance for boys in whom a confident diagnosis of retractile testis is made
