Ectopic Testicle: A Testicle That Completed Its Journey but Ended Up in the Wrong Place

In a true undescended testicle, the testicle has stopped at some point along the normal descent path: in the abdomen, in the inguinal canal, or just above the scrotum. In an ectopic testicle, however, the testicle has passed through the inguinal canal, meaning it has completed most of the journey, but in the final step it has headed toward a neighboring region instead of the scrotum.

The most common location for an ectopic testicle is the superficial inguinal pouch: the testicle has passed the outer opening of the inguinal canal, but instead of descending into the scrotum, it has settled into a pocket under the skin, in front of and to the outer side of the inguinal canal. On examination it can be felt just above the groin crease, close to the skin, and cannot be brought down into the scrotum.

• Superficial inguinal pouch: most common; in front of the inguinal canal, close to the skin
• Femoral region (upper thigh): below the groin crease, on the inner thigh
• Perineum: between the scrotum and the anus
• Base of the penis (prepubic): in front of the pubic bone
• Opposite half of the scrotum (transverse ectopia): very rare; both testicles on the same side

An ectopic testicle is painless and present from birth; that half of the scrotum is empty, and the testicle is felt in an unexpected location. Perineal and femoral locations may be noticed by the family while changing diapers; a testicle in the superficial inguinal pouch, however, is easily mistaken for one in the inguinal canal, and the distinction is made on examination, sometimes only during surgery.

An ectopic testicle does not descend into the scrotum on its own and cannot be brought down with hormone therapy; treatment is surgical. Timing is the same as for other undescended testicles: since it is present from birth, orchiopexy (fixing the testicle in the scrotum) is planned between 6 and 12 months of age, and no later than around 18 months.

In an ectopic testicle, the testicular tissue is usually better preserved than in a testicle positioned high from birth, and because the blood vessel length is adequate, the risk of post-surgical testicular shrinkage (atrophy) or re-ascent is low. Even so, follow-up is recommended a few times during the first year, and then yearly.

• In the long term, as with any child with a history of undescended testicle, testicular development is assessed during adolescence and the teenager is taught self-examination; follow-up continues with the same team into adulthood.