Orchiopexy
An orchiopexy brings an undescended testicle down into the scrotum and fixes it there. It is usually done when a child is between 6 and 18 months old.
Also called Orchidopexy, Undescended testicle surgery, Undescended testis repair, Cryptorchidism surgery, Inguinal orchiopexy, Scrotal orchiopexy, Laparoscopic orchiopexy, Fowler-Stephens orchiopexy
- Where
- Children's hospital or outpatient surgery center
- Anesthesia
- General anesthesia, plus a numbing block such as a caudal block in the lower back or a groin nerve block
- Time in the room
- 45 minutes to 1 hour 30 minutes; longer if laparoscopy is needed
- Hospital stay
- Same day
- Back to normal
- A few days to a week
- Back to work
- Daycare or school in 2 to 5 days; no straddle toys, sports or rough play for about 2 weeks
Overview
Before birth, a baby boy's testicles form inside the belly near the kidneys and slowly move down through the groin into the scrotum. In about 3 in 100 full-term baby boys, and many more born early, one or both testicles have not finished the trip by birth. Many come down on their own in the first few months. If a testicle is still not in the scrotum by 6 months of age (corrected for prematurity), it is unlikely to come down by itself.
American Urological Association guidance is that your child should see a pediatric urologist or surgeon by 6 months of age, and that surgery should be done within the next year, ideally by 18 months. A testicle that stays outside the scrotum is kept at body temperature, which is too warm for it to develop well. Bringing it down early gives it the best chance to grow normally, makes it easy to examine later in life, and repairs a hernia that is often present.
Most undescended testicles can be felt in the groin. For these, your child's surgeon makes a small cut in the groin crease and another in the scrotum, frees the testicle, and fixes it in the scrotum. A testicle sitting low, just above the scrotum, can sometimes be brought down through a single scrotal cut. If the testicle cannot be felt, a tiny camera (laparoscopy) is used to look inside the belly, and the repair is sometimes done in two stages.
An ultrasound is usually not needed before seeing the specialist, because it often cannot find a testicle that the surgeon cannot feel. Hormone shots to make the testicle come down are not recommended in the United States because they rarely work.
The parts of your body involved
As a baby develops before birth, each testicle is guided down from the belly by a cord-like band called the gubernaculum. It passes through the groin canal, a short tunnel in the lower belly wall, and into the scrotum. A thin finger of belly lining, called the processus vaginalis, travels down with it and normally seals shut. An undescended testicle can stop anywhere along this path: inside the belly, inside the groin canal, or just above the scrotum. When it stops, the lining channel usually stays open, which is why a hernia is so often found at surgery. A retractile testicle is different: it is fully descended but is pulled up by a strong muscle reflex, and it can be eased down into the scrotum during an exam.
- Testicle
The gland that will make sperm and testosterone after puberty.
- Groin canal
The tunnel through the lower belly wall where most undescended testicles are found.
- Spermatic cord
The blood vessels and the vas deferens (sperm tube) that run to the testicle. Its length decides how easily the testicle reaches the scrotum.
- Processus vaginalis
A thin channel of belly lining that comes down with the testicle. If it stays open, it forms a hernia sac.
- Scrotum
The pouch of skin where the testicle belongs. On the affected side it may look small or flat.
Why it’s done
Bringing the testicle down protects its development and your child's health later in life. The benefits are greatest when surgery is done early.
- Fertility
A testicle kept at body temperature develops fewer of the cells that later make sperm. Early surgery gives it the best chance.
- Cancer risk and self-checks
Boys with an undescended testicle have a higher than average chance of testicular cancer as adults. Surgery before puberty lowers that risk and puts the testicle where it can be felt and checked.
- Hernia
Most undescended testicles come with an open channel to the belly. It is closed during the operation.
- Twisting and injury
A testicle outside the scrotum is more likely to twist (torsion) or be hurt against the pubic bone.
- Appearance and confidence
A normal-looking scrotum can matter to boys as they grow older.
Other options
- Waiting until 6 months
Many testicles come down on their own in the first few months. Waiting until about 6 months of age (corrected for prematurity) is standard before surgery is planned.
- Watching a retractile testicle
A testicle that can be brought down into the scrotum and stays there for a while does not need surgery, but should be checked about once a year because some later move up for good.
- Hormone treatment
Hormone shots or nasal sprays have been tried, but they rarely work and are not recommended by the American Urological Association.
- Removing the testicle
If a testicle is very small and poorly formed, or only a tiny remnant is found, removing it may be the better choice. A healthy testicle on the other side usually works well.
Getting ready
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After the referral
The week before
The day before
The morning of surgery
In the operating room, step by step
Press play or pick a step. Each drawing shows what your surgeon is doing at that moment. Your team may do some steps differently.
1. Going to sleep
Most young children fall asleep breathing anesthesia gas through a soft mask. The IV is placed after they are asleep. Then a numbing block is given, often a single injection in the lower back called a caudal block, so your child wakes up comfortable.
After the operation
Right afterward
- Waking up
Children often wake up crying or confused. This is usually from the anesthesia, not pain. Holding your child helps most.
- Numb legs
If a caudal block was given, your child's legs may be weak or wobbly for a few hours. This wears off on its own.
- Feeding
Your child can usually drink soon after waking, then eat when hungry.
- Peeing
The team may want to see a wet diaper or that your child has peed before you leave.
- Going home
Most children go home 1 to 2 hours after surgery with a pain plan written for their weight.
At home
- Pain
Give acetaminophen and ibuprofen as directed for the first 2 to 3 days, often on a schedule at first. Stronger medicines are rarely needed.
- The incisions
Skin glue peels off on its own in 1 to 2 weeks. Swelling and bruising of the scrotum and groin are normal and fade over 1 to 2 weeks.
- Diapers
Change diapers often to keep the area clean. Gently wipe away any stool near the incisions.
- Bathing
Sponge baths for the first 2 to 3 days, or as your surgeon advises. Then short tub baths are usually fine. Pat dry.
- Activity
Babies can do their usual things. For toddlers and older children: no straddle toys, ride-on toys, bikes, climbing or rough play for about 2 weeks.
- Car seat
Your child can ride in the car seat as usual. A folded cloth under the straps can ease pressure on the groin.
- Daycare and school
Most children return in 2 to 5 days. Older boys should skip gym and sports for about 2 weeks.
- Follow-up visit
Your surgeon usually checks the testicle's position and size a few weeks to a few months after surgery, and sometimes again later.
Recovery timeline
- Day 0Home the same day
Your child is sleepy and may be fussy. Pain medicine on schedule and lots of cuddles.
- Days 1 to 2Most sore
Your child may be cranky and walk a little stiffly. Swelling and bruising are at their worst.
- Days 3 to 7Back to normal
Most children are playing and eating normally and need little or no pain medicine.
- About 2 weeksFull play
Straddle toys, bikes and rough play are usually allowed again.
- Weeks 4 to 12First check
The surgeon checks that the testicle is staying in the scrotum and has a normal feel.
- 6 months laterSecond stage, if needed
If a two-stage repair was planned, the second operation is usually done about 6 months after the first.
- PubertyTeach self-checks
Teach your son to check his testicles once a month and to tell someone about any lump or change.
- AdulthoodLifelong awareness
As an adult, he should know he had an undescended testicle, because it matters for fertility questions and cancer awareness.
What it feels like
For parents, the hardest part is often handing your child to the operating team. Children usually recover faster than parents expect.
Handing your child over
Many parents feel anxious or teary when their baby goes to sleep or is carried away.
What helpsAsk whether you can stay until your child falls asleep. Bring something to keep your hands and mind busy while you wait, which is often about 1 to 2 hours.
Waking up
Your child may cry hard, thrash or seem not to know you for a few minutes. It can be upsetting to see.
What helpsThis is a common reaction to anesthesia and passes. Hold your child, speak softly, and offer a bottle or breast once the nurses say it is fine.
The first night
Your child may be fussy and sleep more or less than usual.
What helpsKeep pain medicine on schedule for the first day or two. Loose clothes or a diaper one size larger can help.
Diaper changes
Seeing a swollen, bruised scrotum can be alarming.
What helpsSwelling and bruising are expected and fade within 1 to 2 weeks. Call if the swelling is growing, tense or dark purple.
Keeping an active toddler calm
Most children feel well within a few days and want to climb and ride everything.
What helpsQuiet activities like books, puzzles, blocks and screen time help for a couple of weeks. Put straddle toys away for now.
Older boys
An older child may feel embarrassed or worried about his body.
What helpsExplain simply and privately what was done and why. Let him ask questions of the surgeon directly.
How well it works
Success means the testicle stays in the scrotum, keeps a healthy size, and continues to grow with your child.
- Staying down
For a testicle that can be felt in the groin, the operation keeps it in the scrotum in well over 9 out of 10 children. Results are somewhat lower for testicles that start inside the belly.
- Follow-up exams
Your surgeon checks the position and size of the testicle after surgery. Some surgeons also check again a year or more later.
- Fertility
Most men who had one undescended testicle father children. Fertility is more often reduced when both testicles were undescended.
- Cancer awareness
The risk of testicular cancer stays somewhat higher than average, but the testicle is now easy to examine. Monthly self-checks from puberty help find any problem early.
Risks
Every operation has risks. These are the ones people ask about most, with honest odds where good numbers exist. Your surgeon’s own results matter more than averages.
Common
Swelling and bruising of the scrotum and groin for 1 to 2 weeks.
Usually controlled with acetaminophen and ibuprofen for 2 to 3 days.
Some children feel sick or vomit once or twice on the day of surgery. It usually settles by evening with small sips of fluid.
Less common
Redness, warmth or drainage from a cut, usually treated with antibiotics.
A collection of blood in the scrotum or groin. Most settle without treatment.
Scar tissue can pull the testicle up out of the scrotum. A second operation may be needed.
Rare
If its blood supply is harmed, the testicle can shrink. This is rare for testicles that could be felt in the groin and more common after repairs of testicles that started inside the belly.
Damage to the tiny sperm tube can affect fertility on that side later in life.
Serious problems with anesthesia are rare in healthy children.
Call your care team or go to the emergency room if
- Fever of 101°F (38.3°C) or higher
- Swelling in the scrotum or groin that keeps getting bigger, becomes tense, or turns dark purple
- Bleeding that soaks the dressing or diaper and does not stop after 10 minutes of gentle, firm pressure
- Redness spreading from a cut, pus, or a bad smell
- No wet diaper or no peeing for 8 hours
- Vomiting more than a few times, or your child cannot keep fluids down
- Crying or pain that does not ease with the pain medicine
Questions to ask your surgeon
- Can you feel the testicle, and where is it?
- Is it truly undescended, or is it retractile?
- Does my child also have a hernia?
- Do you expect one operation or two?
- Might you need to use laparoscopy?
- What anesthesia and numbing block will my child have?
- How often does the testicle stay down after your repairs?
- What is the chance the testicle shrinks?
- What pain medicine doses should I give at home?
- When can my child bathe, go back to daycare and play normally?
- When are the follow-up visits?
- What does this mean for his fertility and cancer risk as an adult?
Words you may hear
- Undescended testicle
- A testicle that has not moved down into the scrotum.
- Cryptorchidism
- The medical name for an undescended testicle.
- Orchiopexy
- Surgery to bring a testicle down into the scrotum and fix it there. Also called orchidopexy.
- Retractile testicle
- A testicle that is fully descended but is pulled up by a muscle reflex. It can be eased back into the scrotum.
- Nonpalpable testicle
- A testicle that cannot be felt on exam. It may be in the belly, high in the groin, or absent.
- Groin canal
- The tunnel through the lower belly wall that the testicle passes through. Also called the inguinal canal.
- Processus vaginalis
- A thin channel of belly lining that comes down with the testicle and normally closes.
- Hernia
- A bulge of belly contents or fluid through an opening, often the open channel beside the cord.
- Dartos pouch
- The pocket made between the skin and thin muscle layer of the scrotum to hold the testicle.
- Laparoscopy
- Looking inside the belly with a tiny camera through a small cut, usually at the belly button.
- Fowler-Stephens orchiopexy
- A two-stage operation for a testicle high in the belly, in which the main vessels are divided first so new blood supply can develop.
- Caudal block
- A numbing injection in the lower back that blocks pain below the belly button for several hours.
- Corrected age
- A premature baby's age counted from the due date instead of the birth date.
Common questions
Will the testicle come down on its own?
Many do in the first few months of life. If it has not come down by about 6 months of age, corrected for prematurity, it is unlikely to come down by itself.
Why not wait until he is older?
The testicle develops better in the cooler scrotum, and changes from staying too warm start in the first years of life. That is why surgery is recommended by about 18 months.
Is anesthesia safe for a baby?
Anesthesia in healthy children is very safe. A large international study, the GAS trial, found that babies who had about an hour of general anesthesia scored the same on thinking tests at age 5 as babies who had awake numbing instead. Ask the anesthesia team any questions you have.
Will he be able to have children?
Most boys with one undescended testicle father children as adults. Fertility is more likely to be affected when both testicles were undescended.
Does this raise his risk of testicular cancer?
The risk is somewhat higher than average, though still low. Surgery before puberty lowers it and makes the testicle easy to check. Teach him monthly self-exams when he reaches puberty.
What if the surgeon cannot find the testicle?
If it cannot be felt, laparoscopy is used to look inside the belly. Sometimes the testicle is found and brought down. Sometimes it never fully formed, and only a small remnant is found and removed.
What if both testicles are undescended?
Both are usually repaired, sometimes in the same operation. A newborn with neither testicle felt is checked promptly with blood tests for hormone conditions.
Can a testicle that was down move back up later?
Yes. In some boys, a testicle that was in the scrotum as a baby later rises out of it as he grows. This is called an acquired undescended testicle and is also treated with orchiopexy.
Sources this page draws on
- American Urological Association, Evaluation and Treatment of Cryptorchidism: AUA Guideline (amended 2018) (2014)
- European Association of Urology, EAU Guidelines on Paediatric Urology
- Urology Care Foundation, Undescended Testicles
- MedlinePlus (U.S. National Library of Medicine), Undescended testicle repair
- The Lancet, Neurodevelopmental outcome at 5 years of age after general anaesthesia or awake-regional anaesthesia in infancy (GAS trial) (2019)
Written November 2026. This page explains what usually happens. It is not medical advice and does not replace a conversation with your own surgeon, whose plan for you comes first.