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Prof. Dr. Ali Avanoğlu
Hypospadias Surgery • Basics

Hypospadias and Undescended Testes Together

Both conditions are common on their own; occurring together changes the evaluation. Especially when the opening sits further back, additional testing is needed before surgery.

Who this is forChildren whose testes are not in the scrotum
Reading≈3 min
ByProf. Dr. Ali AvanoğluUpdated
This page is part of hypospadias surgery.Read the full treatment overview on the hub page
where it should bePenoscrotal
underside view
01 · Why do they occur together?02 · When is additional testing needed?03 · Can both be corrected in the same operation?04 · Timing
In brief4 madde
  • Why do they occur together?: Both conditions involve structures that take shape at the same stage of pregnancy, largely under the influence of the same hormonal processes.
  • When is additional testing needed?: The determining factor is where the opening is located.
  • Can both be corrected in the same operation?: In most cases, yes.
  • Timing: The recommended window for undescended testis surgery is generally within the first year; the preferred window for hypospadias repair is 6–18 months.
01

Why do they occur together?

Both conditions involve structures that take shape at the same stage of pregnancy, largely under the influence of the same hormonal processes.

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  • The descent of the testis from the abdomen into the scrotum and the closure of the urethral channel all the way to the tip are completed around similar weeks of pregnancy. This is why a disruption in one process can also affect the other.
  • This combination is not, by itself, a diagnosis of disease; but it is regarded as a sign that calls for a more careful evaluation.
02

When is additional testing needed?

The determining factor is where the opening is located. If the opening is close to the tip and only one testis is undescended, standard evaluation is usually enough.

  • A detailed physical exam: position of the testes, structure of the scrotum, size of the penis.
  • Karyotype (chromosome analysis).
  • Hormone profile; stimulation tests depending on the case.
  • Abdominal and pelvic ultrasound.
  • Evaluation of the kidneys and urinary tract.
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  • If the opening is at the base, in the scrotum, or further back, and this is accompanied by an undescended testis, hormonal and genetic evaluation is needed before surgery. A scrotum that appears split in two, or a penis that is noticeably small for the child's age, points in the same direction.
  • The aim is not to attach a label, but to make sure the surgical plan, timing, and long-term follow-up are set up correctly. In most results, no additional problem is found.
03

Can both be corrected in the same operation?

In most cases, yes. Because Prof. Dr. Ali Avanoğlu is also a pediatric surgeon, surgery for undescended testes can be performed in the same session as hypospadias repair.

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  • What this means in practice: the child does not undergo a second round of anesthesia, does not go through a second recovery period, and the family does not have to prepare for a second surgical process.
  • The decision is based on where the testis is located and the scope of the hypospadias repair. If a very extensive repair is planned, the surgeon may prefer to leave the testis to a separate session to shorten the operation.
04

Timing

The recommended window for undescended testis surgery is generally within the first year; the preferred window for hypospadias repair is 6–18 months.

  • These two timeframes overlap considerably, which makes correcting both in one session easier.
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Frequently asked questions
Is it a bad sign for both conditions to occur together?
On its own, it isn't viewed that way. It simply calls for a more detailed evaluation. In most results, no additional problem is found, and the planned repair goes ahead.
What happens if the testes can't be felt by hand?
In that case, imaging and, if needed, laparoscopic evaluation come into play. Evaluation becomes a priority especially when neither testis can be felt.
Will we have to postpone the surgery?
Additional testing is usually completed within a few weeks, and the preferred 6–18 month window for repair can usually still be kept.
Prof. Dr. Ali Avanoğlu's publications on this topic · 1
  1. Tiryaki S, Tekin A, Yagmur İ, et al. (2018). Parental Perception of Terminology of Disorders of Sex Development in Western Turkey. Journal of clinical research in pediatric endocrinology. PubMed ↗
←Previous • BasicsPenile Curvature in ChildrenNext • BasicsHypospadias and Penile Curvature (Chordee)→
Related pagesFull index →
Surgery in ChildrenProximal Hypospadias and Additional EvaluationWhen the opening's proximal position occurs on its own, this evaluation usually isn't needed. But when it's accompanied by an undescended testis, a scrotum divided into two, or a noticeably small penis, a separate evaluation is needed before surgery.Surgery in ChildrenWhat Is Proximal Hypospadias?The urinary opening is at the base of the penis, at the penoscrotal junction, on the scrotum, or further back still. This group makes up roughly a fifth of all cases and is surgically the most demanding — but with a properly planned repair, good outcomes are achieved.BasicsTypes of HypospadiasIn hypospadias, the whole plan starts with a single piece of information: where is the urinary opening? How far back it sits from the tip directly determines which technique is used and how many stages the repair needs.Follow-up and AssessmentPreparing for SurgeryKnowing how the day of surgery will unfold significantly reduces anxiety for both the child and the family. The sections below cover every part of the preparation.
Hypospadias Surgery topic clustersMain treatment page →
Basics 8Surgery in Children 8Surgical Techniques 5After Surgery 9Recurrent Cases 4Hypospadias in Adults 8Follow-up and Assessment 5
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