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Prof. Dr. Ali Avanoğlu
Undescended Testicle • After surgery

What Happens If the Testicle Re-ascends After Orchiopexy?

After orchiopexy (fixing the testicle in the scrotum), the testicle usually stays in place for life. In a small number of children, however, the testicle retracts back toward the upper scrotum or the groin over months or years. This page explains why re-ascent happens, how it is noticed, and when it calls for a second surgery.

Who this is forFamilies told at a postoperative visit that 'the testicle is up' or who notice an empty scrotum
Reading≈5 min
ByProf. Dr. Ali AvanoğluUpdated
This page is part of undescended testicle.Read the full treatment overview on the hub page
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ascending testicle
01 · How common is it?02 · Why does it happen?03 · How is it noticed?04 · Observation or redo orchiopexy?05 · What is done to prevent re-ascent?
In brief5 madde
  • How common is it?: Re-ascent is one of the recognized, monitored outcomes of orchiopexy.
  • Why does it happen?: There are two most common mechanisms: residual tension because the testicle's vessels and cord structures were not sufficiently mobilized during surgery, and scar…
  • How is it noticed?: Re-ascent does not cause pain; it is usually noticed by the family seeing an empty or smaller-looking scrotum on one side, or during a follow-up exam.
  • Observation or redo orchiopexy?: The decision depends on where the testicle has ended up, the child's age, and the testicle's condition.
  • What is done to prevent re-ascent?: Most prevention happens at the first surgery: adequately mobilizing the cord and vessels, closing the hernia sac, and placing the testicle tension-free in a proper…
01

How common is it?

Re-ascent is one of the recognized, monitored outcomes of orchiopexy. Rates reported in the literature vary by center, the testicle's preoperative position, and the technique used, and are usually expressed as low single-digit percentages.

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  • This rate is lowest for testicles that are palpable in the groin and easily brought down to the scrotum. The higher the testicle sits — particularly in intra-abdominal cases and those requiring a staged procedure — the higher both the risk of re-ascent and the risk of atrophy (shrinkage) become.
  • Re-ascent can appear within the first year after surgery, but it can also be noticed years later during a growth spurt; that is why follow-up does not end with the first postoperative visit.
02

Why does it happen?

There are two most common mechanisms: residual tension because the testicle's vessels and cord structures were not sufficiently mobilized during surgery, and scar tissue that forms during healing and pulls the testicle upward.

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  • A testicle brought down under tension may sit in the scrotum during the first weeks, but as the swelling subsides and the child grows, the cord length becomes insufficient and the testicle slides back up. Scar tissue, on the other hand, forms around the inguinal canal and anchors the testicle toward itself.
  • Less common causes include an inadequate fixation pocket (dartos pouch) in the scrotum, a hernia sac that was not closed or has reopened, and dense adhesions related to a postoperative blood collection. In some cases, no clear cause is found.
03

How is it noticed?

Re-ascent does not cause pain; it is usually noticed by the family seeing an empty or smaller-looking scrotum on one side, or during a follow-up exam.

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  • On examination, the doctor checks whether the testicle can be manually brought down into the scrotum and where it stays when released. A testicle that sits in the upper scrotum, comes down with gentle traction, and stays there is usually just observed; a testicle that has retracted into the inguinal canal, does not come down, or comes down and immediately springs back up represents true re-ascent.
  • The same examination compares the testicle's size and consistency with the other side, since a re-ascended testicle may also have shrunk, and the two findings together guide the decision. Imaging is generally not needed for a palpable testicle.
04

Observation or redo orchiopexy?

The decision depends on where the testicle has ended up, the child's age, and the testicle's condition.

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  • A testicle sitting in the upper scrotum that can be comfortably brought down by hand can be monitored with an annual exam, similar to a retractile testicle; it may settle into the scrotum as the child grows. For a testicle that remains in the groin, cannot be brought down by hand, or does not stay in the scrotum, a repeat orchiopexy (redo orchiopexy) is planned; it is recommended without delay so the testicle is not left in a warmer environment.
  • If the testicle appears clearly shrunken and nonfunctional, especially in an adolescent or adult, the option of removal is also discussed; in childhood, however, the testicle is usually preserved and brought down even if it is small. A redo procedure requires more careful planning because of scar tissue; having it performed by a team where two pediatric urologists work together is helpful for protecting the vascular structures.
05

What is done to prevent re-ascent?

Most prevention happens at the first surgery: adequately mobilizing the cord and vessels, closing the hernia sac, and placing the testicle tension-free in a proper pocket in the scrotum.

  • In the postoperative period, what the family can do is follow the activity restrictions and keep to the follow-up schedule. Making a habit of checking the scrotum regularly — for example, during a warm bath — helps you notice any change early.
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Frequently asked questions
Sometimes the testicle isn't visible in the scrotum after surgery — has it re-ascended?
Not always. The cremaster reflex can temporarily pull the testicle up in cold conditions or when touched; it returns to the scrotum during a warm bath or when the child is relaxed. If it stays up persistently or cannot be brought down by hand, schedule an exam.
When should redo surgery be performed?
Once re-ascent is confirmed and the testicle cannot be brought down by hand, it is not delayed for long; it is preferable to wait at least a few months after the first surgery for the swelling and adhesions to settle. Timing is planned individually based on the child's age and the testicle's condition.
Does a re-ascended testicle get damaged?
A testicle that remains in the groin is again exposed to body temperature, and over time this can affect the precursor sperm cells; the testicle's size may also lag behind. This is why correction rather than observation is recommended for true re-ascent — though a short delay does not mean permanent damage.
Should we get an ultrasound?
Ultrasound is not needed to locate a palpable testicle; examination is sufficient. It can help only when an objective measurement of the testicle's volume in the scrotum or groin is needed.
←Previous • After surgeryPostoperative CareNext • After surgeryTesticular Atrophy After Orchiopexy→
Related pagesFull index →
After surgeryRedo OrchiopexyRedo orchiopexy is a second operation on a testicle that was previously brought down to the scrotum but has re-ascended, or that could not be adequately brought down at the first surgery. What sets it apart from the first surgery is that the surgeon is now working within scar tissue, which changes both the planning and the technique. This page explains who needs it, how it is planned, and what families should expect.After surgeryPostoperative CareOrchiopexy (fixing the testicle in the scrotum) is usually outpatient surgery, and the child goes home the same day. Knowing what to expect during the first days at home helps reassure the child and makes it easier to recognize the signs that truly matter. This page walks through the process step by step, from returning home to the first follow-up visit.Follow-upLong-Term Follow-UpUndescended testicle treatment doesn't end with surgery. Whether the testicle stays in place in the scrotum, grows normally, and develops as expected through puberty is monitored over years; follow-up continues seamlessly from pediatric urology into adult urology, and this page walks through that timeline step by step.BasicsAscending TesticleAn ascending testicle is one that was known to be in the scrotum during infancy but moves out of the scrotum during the growing years and can no longer be brought down by hand. It is usually noticed during the preschool and school years. This is why the fact that "it was normal as a baby" is not, on its own, a guarantee; the testicle's position continues to be checked at examinations through school age.
Undescended Testicle topic clustersMain treatment page →
Basics 7Diagnosis and evaluation 6Surgery in children 10Special situations 4After surgery 6Adolescents and adults 6Follow-up 3
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