In the period between 1981 and 1986, 22 microvascular testicular autotransplantations were performed on 18 patients at the Royal Manchester Children's Hospital. The preoperative assessment, the operative technique, and the follow-up results are discussed. Of 22 transplanted testes, four (18.2%) became partially or totally atrophic. The early results are very encouraging; however, only long-term postpubertal follow-up regarding both fertility and malignancy can reveal the real value of this operation.