Impalpable testicle

What is an impalpable testicle?

When the testicle has not ‘dropped’ into the scrotum, it may be in a few places. When your child was examined all these places were felt but no testicle could be found. The possibilities are that the testicle is inside the tummy, or has disappeared.

Why does this operation need to be done?

The testicle may:

• be inside the tummy
• may never have formed
• may have formed and then disappeared

We need to know which of these situations applies to your child so that the testicle can be brought down (if it is there), or to know if there is no testicle.

What would happen if nothing was done?

Testicles which stay in the tummy have a higher tendency to go cancerous later. They also do not produce sperm properly meaning the testicle will be infertile.

It is therefore important not to leave a testicle in the tummy. Even if no testicle is found we can at least be sure that your child will not be at risk from the problems of a hidden testicle later in life.

What operations may be done?

What if they find the testicle when my child is asleep?

Under a general anaesthetic, sometimes a testicle can be found which was difficult to see when your child was awake. In this situation an operation will be done to bring the testicle into the scrotum.

This operation involves a small cut in a skin crease in the groin area and another cut across the scrotum. Through the first cut, the testicle is found and freed up so the cord is long enough for it to come down into the scrotum. The testicle is then fixed in a pouch just under the skin made through the cut in the scrotum.

What if there is some tissue in the groin?

Sometimes a little bit of tissue can be felt in the groin and in this case a cut is made in the groin and this piece of tissue removed and sent to look at under the microscope. This is often a piece of shrivelled up testicle.

What if the testicle still cannot be found?

If no tissue or testicle can be felt in the groin then a keyhole surgery will be needed. This involves passing a telescope through a small hole in the belly button and looking for the testicle.

If a testicle is found just within the tummy then a standard operation is performed.

If the testicle is high then it may be brought down in 2 stages. In the first stage operation some blood vessels to the testicle are cut. These are usually short and prevented the testicle from coming down properly.  We then wait a few months to allow the remaining blood vessels to the testicle to grow larger.  In the second stage operation the testicle can then be brought down to the scrotum using this blood supply.  There is a risk that the testicle may not survive the first operation however.

Both of these operations can be carried out by keyhole surgery with tiny holes in the belly button, and in the left and right sides of the tummy, or through a cut in the groin.

Sometimes it is not worth trying to bring the testicle down. This will be if the testicle is very high and will be difficult to bring down, or is poorly formed and not likely to function. In this situation the testicle may be removed by the keyhole surgery technique or through a small cut in the groin.

Whatever operation is done any stitches used will be dissolving and will not need to be removed.

What will happen afterwards and what will the recovery be like?

Keyhole surgery is tolerated well by children. They may have some tummy pain for about 24 hours afterwards but it usually settles after this. There may also be some shoulder tip pain for 24 hours.

If your child had groin or scrotal cuts, the area will be sore for a couple of days so regular paracetamol will help this. Children are usually back to normal activity within a few days. There is always some bruising and thickening in the scrotum. The bruising will settle fairly quickly but the thickening may take a few months to resolve.

Older boys may experience more discomfort and will need to stay away from active sports (except swimming) for 2 to 3 weeks.

What complications can happen from the surgery?

The risk of the testicle not growing or shrinking is about 1 in 5 overall if the two stage operation is needed.  It usually better to try to move the testicle however as the alternative would be to remove it.

There is a later risk that scar tissue can pull the testicle higher again which may need a later operation to move it back down again.  This risk is about 1 in 50.

Any operation carries a small risk of bleeding and bruising.  There is also a small risk of a wound infection which may need antibiotics to treat.

Will there need to be any medical check up after surgery?

When the testicle is brought down your child will need to be seen between 6 to 12 months after surgery to see the results.

If a bit of tissue was taken out from the groin then you will be seen a few weeks afterwards to discuss what the tissue was.

If the testicle is being brought down in 2 stages you will be sent an appointment to come in for the second stage, but will not necessarily need to be seen in between.