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Prof. Dr. Ali Avanoğlu
Undescended Testicle • Special situations

Atrophic Testicular Remnant (Nubbin): What Is It and Why Is It Removed?

A nubbin (atrophic testicular remnant) is a few millimeters of non-functional tissue left behind from a testicle whose blood supply was disrupted before birth, usually found in the inguinal canal or the upper scrotum. It is frequently encountered during the workup of a non-palpable testicle; most centers recommend removing it and sending it for pathological examination.

Who this is forFamilies of children found to have a testicular remnant in the groin or scrotum
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ByProf. Dr. Ali AvanoğluUpdated
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01 · What is a nubbin, and how does it differ from vanishing testis?02 · How is it identified?03 · Why is it removed?04 · How is the procedure performed?05 · The remaining testicle and follow-up
In brief5 madde
  • What is a nubbin, and how does it differ from vanishing testis?: A nubbin is one outcome of the vanishing testis process: the testicle formed in the womb, its blood supply was disrupted during or after descent, and it atrophied…
  • How is it identified?: A nubbin is most often found during the workup for a non-palpable testicle; a definitive diagnosis is not always possible before surgery.
  • Why is it removed?: Removal of a nubbin is recommended at most centers; the reasoning is both diagnostic and protective.
  • How is the procedure performed?: Removing a nubbin is a small, brief procedure, usually completed in the same session as the workup for a non-palpable testicle.
  • The remaining testicle and follow-up: After the nubbin is removed, the child has a single functioning testicle, and that testicle is worth protecting.
01

What is a nubbin, and how does it differ from vanishing testis?

A nubbin is one outcome of the vanishing testis process: the testicle formed in the womb, its blood supply was disrupted during or after descent, and it atrophied, leaving behind a small remnant.

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  • The difference lies in where the remnant is located. In vanishing testis, the vessels most often end blindly inside the abdomen, and no tissue remains that can be felt by hand. A nubbin, by contrast, has largely completed its descent; the remnant sits in the inguinal canal or the upper scrotum, and on careful examination it can sometimes be felt as a small, firm point.
  • The remnant typically contains fibrous tissue, calcification, and hemosiderin (a trace of old bleeding); these findings support the explanation of torsion before birth. In a small proportion of cases, living testicular tissue or sperm precursor cells may be found; what this means is discussed below.
02

How is it identified?

A nubbin is most often found during the workup for a non-palpable testicle; a definitive diagnosis is not always possible before surgery.

  • One side of the scrotum is empty and small, with marked enlargement of the other testicle
  • A small, firm point in the inguinal canal or upper scrotum
  • Vessels and duct entering the inguinal canal at laparoscopy
  • A few millimeters of pale tissue found on inguinal exploration
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  • On examination, that side of the scrotum is empty and underdeveloped; an experienced examiner may feel a small remnant in the inguinal canal or the upper scrotum. Marked enlargement of the other testicle (compensatory growth) can suggest a lost testicle, but does not establish the diagnosis on its own. Ultrasound sometimes shows the remnant, but since not seeing it doesn't mean it's absent, and seeing it isn't definitive either, guidelines do not recommend routine imaging.
  • Definitive assessment is made with re-examination under anesthesia and diagnostic laparoscopy (a minimally invasive approach). If laparoscopy shows the testicular vessels and sperm duct passing through the internal ring into the inguinal canal, the groin is opened; a living testicle or a nubbin is found there. In our practice, these steps are completed in a single session with joint assessment by two pediatric urologists.
03

Why is it removed?

Removal of a nubbin is recommended at most centers; the reasoning is both diagnostic and protective.

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  • The diagnostic reasoning is simple: the excised tissue is sent for pathological examination, which confirms that it truly is an atrophied remnant — closing, once and for all, the question of whether a living testicle remains somewhere in the groin. The protective reasoning is that a small proportion of remnants contain living sperm precursor cells or testicular tissue. Even though the likelihood of these cells causing problems later is very low, tissue in the inguinal canal is difficult to examine over time, so most pediatric urologists prefer not to leave it in place.
  • There is also an opposing view: some argue that the rate of living cells in remnants is low, that reports of malignant change are extremely rare, and that an additional incision may be unnecessary. Practice varies by center; our physicians discuss this with the family and, in most cases, follow the path of removal and pathological examination.
04

How is the procedure performed?

Removing a nubbin is a small, brief procedure, usually completed in the same session as the workup for a non-palpable testicle.

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  • If the remnant is in the inguinal canal, it is removed through a small groin (inguinal) incision; if it is in the upper scrotum, it is removed through a single scrotal incision. The procedure is done on a day-surgery basis, and the child goes home the same day. Pain is managed with simple pain relievers, and a return to daily activities follows within a few days.
  • Whether the remaining testicle should be fixed in place during the same session is discussed with the family beforehand; this is a debated point and practice varies by center. In our practice, this decision is made together, based on the child's situation and the family's preference.
05

The remaining testicle and follow-up

After the nubbin is removed, the child has a single functioning testicle, and that testicle is worth protecting.

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  • A single healthy testicle is usually sufficient for hormone production and fertility; paternity rates in cases of a unilateral history have been reported close to those of the general population. Annual checkups monitor the position and growth of the remaining testicle, its volume is assessed during adolescence, and the teenager is taught self-examination. Sudden, severe testicular pain is always an emergency.
  • If the appearance of the empty side bothers the teenager during adolescence, a testicular prosthesis can be discussed. Follow-up continues with the same team from childhood into adulthood.
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Frequently asked questions
When do the pathology results come back, and what is expected to be found?
Results are usually available within a few weeks. The expected findings are traces of old circulatory damage, such as fibrous tissue, calcification, and hemosiderin. Living testicular tissue or sperm precursor cells are rarely reported; even in that case, follow-up does not change, since the remnant has already been removed, and the result is discussed with you.
What happens if the nubbin is not removed?
In most cases, nothing happens; the remnant simply stays in place without causing symptoms. However, a definitive diagnosis is not made, and tissue in the inguinal canal is difficult to examine later on. For these reasons, most centers prefer removal; the decision is made together with the family.
The ultrasound report says 'atrophic testicle' — is surgery necessary?
Ultrasound is not reliable for a non-palpable testicle; the small tissue it identifies could be a living testicle or a remnant. Definitive assessment is made with examination under anesthesia and, if needed, laparoscopy; if a living testicle is found, it is brought down in the same session, and if a remnant is found, it is removed.
Should we be concerned if the other testicle is larger?
No. When only one testicle remains, some enlargement of that testicle is an expected adaptive response (compensatory growth), not a disease. Its size and consistency are monitored at annual checkups, and self-examination is taught starting at adolescence.
←Previous • Special situationsVanishing TestisNext • Special situationsTesticular Agenesis (Absent Testicle)→
Related pagesFull index →
Special situationsVanishing TestisVanishing testis refers to a testicle that formed in the womb but was lost at some point in development when its blood supply was disrupted. It is one of the most common causes of a non-palpable testicle; the diagnosis is made at laparoscopy when blind-ending vessels are seen, meaning there is no testicle left to bring down.Diagnosis and evaluationDiagnostic LaparoscopyDiagnostic laparoscopy (a minimally invasive procedure) is direct visualization of the inside of the abdomen through a thin camera introduced at the navel, and it's the only method that definitively answers both 'is there a testicle' and 'where' in a non-palpable testicle. This page explains how the procedure is performed and how the plan proceeds for every possible finding.Surgery in childrenUndescended Testicle in the Groin: Inguinal OrchiopexyAn undescended testicle palpable in the groin accounts for the large majority of cases and is the group with the most predictable treatment. Inguinal (groin) orchiopexy is the standard approach for this testicle: the testicle is freed through a small groin incision, the hernia sac is closed, and the testicle is fixed in the scrotum.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.
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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