Undescended Testicle Diagnosed Late: What Happens in Adolescence?

The undescended testicle we encounter in adolescence usually comes from one of three paths: a diagnosis missed in infancy, a testicle that was in the scrotum but ascended upward over the years (an “ascending” testicle), or a testicle that was thought to be retractile (shy) in childhood and dropped out of follow-up.

Evaluation again starts with a physical exam: is the testicle palpable, where is it located, and how does its size and consistency compare with the other testicle? In adolescents the exam is done in a warm room, both standing and lying down, taking the cremasteric reflex into account.

For a testicle that is palpable in the groin or above the scrotum and of a reasonable size, the standard recommendation is orchiopexy (fixing the testicle in the scrotum). Orchiopexy performed at adolescent age is not technically different from the childhood procedure; the incision may be slightly larger and recovery may take a few days longer.

An intra-abdominal testicle found in adolescence is the situation that requires the most careful handling. A testicle that has remained in a warm environment for years usually has a reduced sperm-producing capacity, and this group carries the highest risk of testicular cancer.

With a history of a unilateral undescended testicle, even when treated late, the paternity rate is reported to be close to that of the general population, thanks to the healthy other testicle. In bilateral cases, sperm parameters are markedly affected, and a hormone profile in adolescence with later sperm analysis is planned.

• Testicular cancer risk is elevated compared with the general population in men with a history of an undescended testicle; orchiopexy performed before puberty has been reported to reduce this risk, while repair done after puberty does not significantly reduce it. For this reason, the adolescent patient is taught monthly testicular self-examination, and any suspicious firmness is evaluated without delay.

The adolescent patient is now part of the decision. The exam and the options are explained to him directly, openly, and without judgment; embarrassment and anxiety are natural and can be talked about.

• On this team, pediatric urology and adult urology work side by side; evaluation that begins in adolescence continues seamlessly into fertility and cancer follow-up in adulthood.