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Prof. Dr. Ali Avanoğlu
Undescended Testicle • Follow-up

What Does Long-Term Follow-Up Look Like After Undescended Testicle Surgery?

Undescended 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.

Who this is forFamilies of children who have had orchiopexy, and young people who have undergone surgery
Reading≈6 min
ByProf. Dr. Ali AvanoğluUpdated
This page is part of undescended testicle.Read the full treatment overview on the hub page
OBSERVATIONCan descend on its ownTARGET WINDOWOrchiopexyAT THE LATESTDon't delayFOLLOW-UP · DECISIONEvaluated at any ageBIRTH6 MO12 MO18 MOPUBERTYADULTINDIVIDUAL DECISION IN ADOLESCENTS AND ADULTS
surgical timing
01 · Why is follow-up necessary?02 · The first year: incision, position, and early growth03 · The childhood years: annual exams04 · Puberty: volume, hormones, and awareness05 · Adulthood: semen analysis and ongoing monitoring
In brief5 madde
  • Why is follow-up necessary?: Orchiopexy (surgically fixing the testicle in the scrotum) brings the testicle to the correct location; but the operation's true goals — preserving reproductive…
  • The first year: incision, position, and early growth: The first year after surgery is when it becomes clear whether the testicle is staying in the scrotum and whether there are any signs of early atrophy (shrinkage).
  • The childhood years: annual exams: From the first year until puberty, follow-up consists of one exam per year — brief, but essential.
  • Puberty: volume, hormones, and awareness: Puberty is the most informative period in the history of an undescended testicle, because the testicle's true growth capacity becomes apparent during these years.
  • Adulthood: semen analysis and ongoing monitoring: In adulthood, the reasons for follow-up change: plans to have children, shrinkage or firmness in the testicle, or swelling in the groin.
01

Why is follow-up necessary?

Orchiopexy (surgically fixing the testicle in the scrotum) brings the testicle to the correct location; but the operation's true goals — preserving reproductive potential and keeping the testicle in a place where it can be examined — are achieved only over the following years.

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  • Follow-up serves three concrete purposes. First, to confirm that the lowered testicle stays in the scrotum: in a small proportion of cases, scar tissue can pull it back up, and this is corrected when caught early. Second, to track the testicle's growth: a testicle that remains noticeably smaller than the other side, or that shrinks, is evaluated further. Third, testicular cancer risk: orchiopexy performed before puberty lowers this risk but does not eliminate it, which is why awareness and self-examination continue for life starting in adolescence.
  • In our practice, follow-up is managed jointly in a shared file by two pediatric urology specialists and continues with the same team into adulthood; the surgical record, testicular size measurements, and any pathology results from childhood also form the basis for decisions made later in adult life.
02

The first year: incision, position, and early growth

The first year after surgery is when it becomes clear whether the testicle is staying in the scrotum and whether there are any signs of early atrophy (shrinkage).

  • Can the testicle be felt in the scrotum, or has it pulled back toward the groin?
  • Has its size noticeably decreased, or has its consistency changed?
  • Is there any new swelling in the groin, or a growing mass in the scrotum?
  • Sudden, severe pain: this is an emergency — evaluate for torsion.
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  • The first checkup is usually done a few weeks after surgery, evaluating the incision, any swelling, and the testicle's position in the scrotum. Subsequent visits are typically scheduled around six months and one year after surgery; at these visits, the testicle's position is confirmed, its size is compared with the other side, and this is recorded by physical exam or, if needed, ultrasound. In staged procedures (Fowler–Stephens or Shehata), this monitoring may be more frequent, because the risk of atrophy is higher for a testicle that started high in the abdomen.
  • What families should watch for during this period is simple: that the testicle can be felt inside the scrotum, that its size hasn't noticeably decreased, and that there's no new swelling in the groin. If anything seems off, don't wait for the scheduled appointment.
03

The childhood years: annual exams

From the first year until puberty, follow-up consists of one exam per year — brief, but essential.

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  • At the annual checkup, the testicle's position in the scrotum is confirmed, its size is compared with the other side, and any difference is assessed against the previous measurement. These visits are also an opportunity to monitor the other testicle: in children who had surgery on one side only, the other testicle can later ascend (an "ascending testicle"), and this possibility is kept in mind until school age.
  • The same principle applies to children being monitored without surgery for a retractile testicle: at least one exam per year until puberty, because in some cases the testicle genuinely does ascend over time. Having the testicle's position checked during family doctor or pediatrician visits supports this monitoring, but it does not replace the pediatric urology checkup.
04

Puberty: volume, hormones, and awareness

Puberty is the most informative period in the history of an undescended testicle, because the testicle's true growth capacity becomes apparent during these years.

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  • Once puberty begins, testicular volume is measured with an orchidometer (a measuring tool resembling a string of beads of different sizes) or with ultrasound, and compared with the other testicle. It's common for the operated testicle to remain somewhat smaller than the other side, and this alone isn't a problem; if the difference is significant, or if expected pubertal development is delayed, hormones such as FSH, LH, testosterone, and inhibin B are evaluated. In teens with a history of bilateral undescended testicles, this evaluation is done more closely, and pediatric endocrinology is involved when needed.
  • During this period, the teen is taught monthly testicular self-examination. The goal isn't to alarm them, but to help them become familiar with the testicle's normal consistency so they can notice any firmness or growth early; because testicular cancer risk remains higher than average in those with a history of an undescended testicle, this habit continues for life.
05

Adulthood: semen analysis and ongoing monitoring

In adulthood, the reasons for follow-up change: plans to have children, shrinkage or firmness in the testicle, or swelling in the groin. Each has its own path for evaluation.

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  • Reproductive capacity is definitively assessed in adulthood through semen analysis and a hormone profile. In those with a history of unilateral undescended testicle, the paternity rate is close to that of the general population; in bilateral cases, semen parameters can drop significantly, and in this group early semen analysis is recommended, along with reproductive planning with adult urology if needed. Self-examination continues; any suspicious finding is quickly evaluated with scrotal ultrasound.
  • In our practice, adult urology is under the same roof; the file that begins in childhood continues with the same physicians through adolescence and adulthood. This continuity is the most practical way to catch late-developing problems early.
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Frequently asked questions
How many follow-up visits will we need after surgery?
Usually two or three times in the first year: a few weeks after surgery, and again around six months and one year. After that, once a year until puberty; monitoring may be somewhat closer during puberty. For staged procedures, first-year checkups are scheduled more frequently.
The testicle is in the scrotum and the child is doing fine — can we skip the checkup?
We continue to recommend the annual checkup. The testicle re-ascending, the other testicle later ascending, and growth differences are usually painless and silent — but they're resolved when caught early. The exam only takes a few minutes.
Is an ultrasound done at every checkup?
No. The exam is the foundation of follow-up. Ultrasound is used to measure volume during puberty, when there's a suspected significant size difference or change in consistency, and for suspicious findings in adulthood.
When should self-examination start?
It's taught once puberty begins, usually around age 13–15, and is recommended once a month. The goal is for the teen to become familiar with the normal consistency of their own testicle and to report any new firmness or growth without delay.
Is semen analysis needed for everyone in adulthood?
Semen analysis is recommended when transitioning into adulthood for those with a history of bilateral undescended testicles, because reproductive potential can be reduced in this group. For a unilateral history, the paternity rate is close to that of the general population; it's done if there are plans to have children, smallness of the testicle, or a hormonal finding.
Next • Follow-upDoes the Testicle Grow Normally After Surgery?→
Related pagesFull index →
Follow-upDoes the Testicle Grow Normally After Surgery?This is the question families ask most often after surgery: will the lowered testicle grow? In most cases, yes — a testicle brought down into the scrotum grows through childhood and puberty, though it may remain somewhat smaller than the other side. This page explains when that difference is expected and when it's a finding that needs further evaluation.Follow-upCheckups During Puberty and AdulthoodAn undescended testicle that was operated on in childhood still deserves monitoring during puberty and adulthood. By this stage, the question is no longer 'is the testicle in the scrotum,' but 'is it developing as expected, what is reproductive capacity like, and is there awareness around cancer risk.' This page is written for teens, young adults, their families, and adults who had surgery in childhood.After surgeryTesticular Re-ascent After OrchiopexyAfter 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.Adolescents and adultsTesticular Self-ExaminationTesticular cancer risk is elevated compared with the general population in young men with a history of an undescended testicle, and early diagnosis makes treatment much easier. A few minutes of self-examination once a month lets you get to know your own testicles and notice a change early. This page explains the steps of the exam, what to look for, and when to see a doctor.
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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