Orchiopexy or Orchiectomy? The Testicle Decision in Adults

Orchiopexy is the release of the testicle and its vascular structures and its tension-free placement and fixation in the scrotum; the testicle is preserved, its contribution to hormone production continues, and it becomes accessible to manual examination. Orchiectomy, on the other hand, is removal of the testicle along with its blood vessels; the tissue is sent for pathological examination, and the cancer risk associated with that testicle is eliminated.

If the testicle is judged worth preserving, bringing it down is favored. Although orchiopexy performed after puberty does not significantly reduce cancer risk, having the testicle in the scrotum allows a possible mass to be noticed early.

• If the testicle is close to normal size, has good consistency, and appears structurally normal on ultrasound.
• If the contribution to hormone production matters: the other testicle is small, has limited function, or is absent.
• In bilateral undescended testicle: an effort is made to preserve each testicle.
• If the patient prefers to preserve the testicle and accepts lifelong regular follow-up.
• If the testicle is palpable in the groin and there is enough vessel length for a tension-free descent.

If the risk carried by a non-functional testicle outweighs its benefit, removal is recommended. This applies especially to testicles that have remained intra-abdominal and reached beyond puberty; cancer risk is highest in this group and sperm production has usually been lost.

• If the testicle is markedly small, soft, and non-functional; and the other testicle is healthy and normal-sized.
• If the intra-abdominal testicle is post-pubertal, difficult to bring down, or structurally abnormal.
• If there is a suspicious area on ultrasound, a mass, or elevated tumor markers.
• If the patient prefers to eliminate cancer concern entirely.
• If a testicular remnant (nubbin) or a testicle that underwent torsion and lost viability is found.

The period from after puberty to roughly age 50 is the range most debated in decision-making. Testicular cancer is most common in young adulthood; for this reason, in this age group, removal is more often preferred for a non-functional testicle, and descent with close follow-up for a functional one.

If orchiopexy is chosen, monthly self-examination and regular physician checkups continue for life; the other testicle is also monitored. If orchiectomy is chosen, the pathology result is reviewed and the remaining testicle is monitored regularly; protecting the single remaining testicle becomes important.