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Undescended Testicle • After surgery

Testicular Atrophy After Orchiopexy: Why It Happens and How It's Monitored

Testicular atrophy is the shrinking of the testicle after surgery and the partial or complete loss of its function. It is one of the most discussed long-term outcomes of orchiopexy (fixing the testicle in the scrotum), and the risk varies significantly depending on the testicle's preoperative position. This page explains the causes, the higher-risk groups, and how it is monitored.

Who this is forFamilies told 'the testicle has shrunk' or that it is 'smaller than the other side'
Reading≈5 min
ByProf. Dr. Ali AvanoğluUpdated
This page is part of undescended testicle.Read the full treatment overview on the hub page
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in the scrotum
01 · What is testicular atrophy, and why does it happen?02 · Which cases carry higher risk?03 · How is it monitored?04 · What changes if atrophy develops?05 · Team and follow-up
In brief5 madde
  • What is testicular atrophy, and why does it happen?: The testicle is supplied by several blood sources: the main testicular artery, a vessel running along the vas deferens (sperm duct), and the cremasteric vessel.
  • Which cases carry higher risk?: The general rule is clear: the higher the testicle sits, the higher the risk of atrophy.
  • How is it monitored?: At postoperative visits, the testicle's size is compared with the other side — several times during the first year, then at annual checkups afterward.
  • What changes if atrophy develops?: In one-sided atrophy, if the other testicle is healthy, hormone production and future fertility potential are usually preserved; the other testicle typically…
  • Team and follow-up: Minimizing the risk of atrophy starts with gentle handling of the vessels at the first surgery, avoiding tension, and planning a staged approach from the outset when…
01

What is testicular atrophy, and why does it happen?

The testicle is supplied by several blood sources: the main testicular artery, a vessel running along the vas deferens (sperm duct), and the cremasteric vessel. Stretching, compression, or injury to these vessels during surgery can reduce blood flow; when the blood supply is insufficient, testicular tissue shrinks.

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  • A testicle brought down into the scrotum may look smaller in the first months as swelling subsides; this is not atrophy. In true atrophy, the testicle stays clearly smaller than the other side, its consistency becomes softer, and it does not grow over time.
  • Part of the small size is not due to the surgery but to the testicle's congenital development: a testicle that has remained in the abdomen or groin for years is already small before surgery and may not catch up to the other testicle even after being brought down. A preoperative size record is important for distinguishing between these two situations.
02

Which cases carry higher risk?

The general rule is clear: the higher the testicle sits, the higher the risk of atrophy. For testicles palpable in the groin that come down to the scrotum easily, the literature reports low risk percentages; the risk is markedly higher for intra-abdominal testicles, and particularly in cases requiring a staged procedure because the vessel length is insufficient.

  • Intra-abdominal or high-positioned testicle
  • Staged surgery, especially Fowler-Stephens
  • A groin that has already had surgery (redo orchiopexy)
  • Postoperative blood collection or infection
  • A congenitally small, underdeveloped testicle and surgery performed at a later age
  • In the Fowler-Stephens technique, the main testicular vessel is deliberately divided and the testicle is supplied through collateral circulation, so the risk of atrophy is higher than with single-stage orchiopexy; the two-stage approach has a better testicular survival rate than the single-stage version. In the Shehata (traction) technique, the main vessel is preserved, and a lower risk has been reported; the literature is still maturing for a definitive comparison.
03

How is it monitored?

At postoperative visits, the testicle's size is compared with the other side — several times during the first year, then at annual checkups afterward.

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  • On examination, size is assessed with an orchidometer (a set of measuring beads); if there is any doubt, an ultrasound volume measurement provides an objective comparison. Here, the ultrasound is not used to search for a non-palpable testicle but to measure the volume of a testicle already in the scrotum, and it is reliable for that purpose.
  • A definitive judgment is made after waiting through the first year, to see the swelling subside and whether the testicle keeps growing. Because the testicle grows rapidly during puberty, differences become clearer at that stage; a testicle that remains markedly smaller than the other side is addressed with a hormonal evaluation.
04

What changes if atrophy develops?

In one-sided atrophy, if the other testicle is healthy, hormone production and future fertility potential are usually preserved; the other testicle typically undergoes compensatory growth.

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  • An atrophic testicle is usually left in the scrotum; even if its function is minimal, it does not need to be removed. However, it is evaluated if there is a palpable irregularity or suspicion of a mass after puberty; in adults, the option of removing a small, nonfunctional testicle can be discussed individually.
  • Bilateral atrophy, or atrophy in a child with only one testicle, is a separate matter: hormone levels are monitored together with endocrinology, pubertal development is tracked, and testosterone support is planned if needed. In these children, protecting the remaining testicle from impact, torsion, and hernia is especially important.
05

Team and follow-up

Minimizing the risk of atrophy starts with gentle handling of the vessels at the first surgery, avoiding tension, and planning a staged approach from the outset when needed. In a team where two pediatric urologists work together, these decisions are made through joint assessment during surgery.

  • Follow-up continues with the same team from childhood through adolescence and adulthood; since adult urology operates under the same roof, size, hormone levels, and, if needed, semen analysis are evaluated together.
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Frequently asked questions
The testicle looks small a month after surgery — is that atrophy?
In the first months, the subsiding of swelling can make the testicle look smaller than right after surgery; this is a natural process. A diagnosis of atrophy requires comparison with the other testicle and monitoring growth over time; a definitive judgment is usually made at the end of the first year.
Should an atrophic testicle be removed?
Generally not in childhood; the testicle is left in the scrotum and monitored. After puberty or in adulthood, the option of removing a small, nonfunctional testicle that is difficult to examine can be discussed individually; the decision is made together with the patient's preference and the condition of the other testicle.
Can a shrunken testicle grow back?
If blood flow has been seriously compromised, tissue loss is not reversible. However, the small appearance in the first months is often not true atrophy, and the testicle continues to grow; this is why a definitive judgment is avoided early on.
Is the other testicle enough on its own?
A single healthy testicle is sufficient for hormone production and, in most cases, for fertility; paternity rates in a history of one-sided undescended testicle have been reported to be close to the general population. This is why protecting and regularly monitoring the other testicle is important.
What does it mean if one testicle is smaller than the other?
A small size difference between the two testicles is normal; a marked difference should be evaluated. In a child who has had surgery, the testicle that was brought down staying smaller than the other side is due either to compromised tissue blood supply (atrophy) or to the testicle already being small before surgery; the preoperative size record is used to distinguish between the two. Measurement is done on exam with an orchidometer, and by ultrasound volume measurement if there is doubt, and it becomes more reliable at the end of the first year.
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Related pagesFull index →
Surgery in childrenHigh Intra-Abdominal Undescended TesticleSome intra-abdominal testicles sit far from the internal ring, with vessels too short to reach the scrotum. For this ‘high intra-abdominal’ testicle, forcing it down would compromise its blood supply, while leaving it in place would keep it in a warm environment; staged techniques were developed to resolve this dilemma.Surgery in childrenFowler–Stephens OrchiopexyFowler–Stephens orchiopexy is a staged technique developed for a high intra-abdominal testicle whose vessels don’t reach the scrotum. The main testicular vessel is divided, and the testicle is entrusted to the collateral circulation running along the vas deferens; it is brought down into the scrotum in a second session about six months later.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-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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