Undescended Testicle in Adults: How Is the Decision Made?
In adults, an undescended testicle most often comes to light during an infertility workup, as groin swelling, or as an incidental finding on imaging. At this age, the decision is guided by different principles than in infancy: the goal is to weigh the testicle's function, the condition of the other testicle, the desire for children, and testicular cancer risk together. This page explains the evaluation steps and decision factors for the adult patient.
Who this is forMen diagnosed with an undescended testicle in adulthood, or those untreated since childhood
How does an undescended testicle noticed in adulthood come to light?: In adults, an undescended testicle is usually noticed during an exam done for another reason: an infertility workup, a military or pre-employment physical, groin…
Steps of evaluation: Evaluation starts with a physical exam and is completed with a few tests depending on the purpose; not every test is needed for every patient.
Factors that determine the decision: In adults there is no single correct answer; the decision is made by weighing several factors together.
Undescended testicle surgery at 20–30: options: For a palpable testicle of reasonable size, orchiopexy (fixing the testicle in the scrotum) is performed; the testicle is brought to a place where it can be examined…
Follow-up afterward: If the testicle was brought down into the scrotum, lifelong monthly self-examination and regular physician checkups are recommended; orchiopexy does not significantly…
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How does an undescended testicle noticed in adulthood come to light?
In adults, an undescended testicle is usually noticed during an exam done for another reason: an infertility workup, a military or pre-employment physical, groin swelling or pain, or an incidental finding on abdominal imaging.
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In some cases the patient is aware of the condition but it was not treated in childhood, or he was told ‘it won't be a problem’; in others, he learns for the first time that he has only one testicle in the scrotum. In both situations the approach is the same: no judgment, planning based on the current situation.
In adults, a non-palpable testicle that has remained in the abdomen may, though rarely, first present with a mass or torsion (twisting); sudden, severe abdominal or groin pain in these patients is evaluated urgently.
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Steps of evaluation
Evaluation starts with a physical exam and is completed with a few tests depending on the purpose; not every test is needed for every patient.
Exam: is the testicle palpable, its location, size, and consistency; the volume and consistency of the other testicle; check for groin hernia and varicocele.
Scrotal and groin ultrasound: the volume and structure of the testicle in the scrotum; imaging of a palpable testicle in the groin. Ultrasound and MRI are not reliable for an intra-abdominal testicle; for a non-palpable testicle, diagnostic laparoscopy (a closed technique) is the standard.
Hormone profile: FSH, LH, testosterone; inhibin B when needed. This gives information about testicular function and the compensatory capacity of the other testicle.
Sperm analysis: for every patient who wants children or wants to know his fertility status; mandatory in a bilateral history.
Tumor markers (AFP, hCG, LDH): when an intra-abdominal testicle or mass is suspected.
Diagnostic laparoscopy: to see the location, size, and structure of a non-palpable testicle; depending on the findings, bringing it down or removing it can be done in the same session.
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Factors that determine the decision
In adults there is no single correct answer; the decision is made by weighing several factors together.
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Age: from after puberty to roughly age 50, testicular cancer risk accumulates the most during this period and this weighs in favor of intervention; at older ages, surgical risk becomes more prominent and observation may become an option. The size and function of the testicle: a testicle close to normal size that produces hormones is worth preserving; for a markedly small, non-functional testicle, removal gains weight as an option.
The other testicle: a healthy, normal-sized other testicle makes it easier to remove a non-functional one; if the other testicle also has a problem, an effort is made to preserve both. Desire for children and the patient's preference: this is central to the decision; some patients want to preserve the testicle even with limited function, while others want to eliminate cancer concern entirely.
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Undescended testicle surgery at 20–30: options
For a palpable testicle of reasonable size, orchiopexy (fixing the testicle in the scrotum) is performed; the testicle is brought to a place where it can be examined, its hormone-producing tissue is preserved, and self-examination becomes possible.
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For a markedly small, non-functional, or structurally abnormal testicle, especially if the other testicle is healthy, orchiectomy (removal of the testicle) may be recommended; the removed tissue is sent for pathological examination. Patients who wish can have a testicular prosthesis placed in the same session or later.
For an intra-abdominal testicle, the decision becomes clear during surgery based on the laparoscopy findings; if the testicle can be brought down and is judged worth preserving, laparoscopic orchiopexy is performed, otherwise laparoscopic orchiectomy is completed in the same session. Both possibilities are discussed with the patient in the pre-operative consultation. In older patients with coexisting illness and high surgical risk, observation with regular exams and imaging is an option.
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Follow-up afterward
If the testicle was brought down into the scrotum, lifelong monthly self-examination and regular physician checkups are recommended; orchiopexy does not significantly reduce cancer risk in adults, but it does make early detection possible.
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The other testicle is also part of follow-up; a history of an undescended testicle is reported to slightly raise the risk in the other testicle as well. If there is a plan for fertility, sperm analysis and hormone levels are monitored; reproductive medicine is involved when needed.
On this team, adult urology and pediatric urology work side by side; an adult who was or was not treated in childhood is evaluated under the same roof.
I haven't had any problems for years; why do something now?
An undescended testicle usually causes no symptoms; the concern relates to future cancer risk and reproductive capacity. Getting evaluated does not mean mandatory surgery; the goal is to know the situation and determine the option that's right for you together.
Does orchiopexy in adults reduce cancer risk?
Orchiopexy performed after puberty is reported not to significantly reduce risk. Its benefit is bringing the testicle to a place where it can be easily examined and preserving hormone tissue; this way, a possible mass is noticed early.
Does living with one testicle affect health?
A single healthy testicle is sufficient for hormone production and, in most cases, for reproduction. However, protecting and regularly monitoring the remaining testicle becomes important; patients who wish can have a prosthesis placed for cosmetic purposes.
How much time do I have to decide?
Unless there is an emergency (torsion, suspected mass), it's possible to take time to think it over and get a second opinion if needed. Once testing is complete, the options are explained clearly and the process is planned together with you.
Can undescended testicle surgery be done at age 30?
Yes, an undescended testicle diagnosed in adulthood is evaluated and an intervention is planned in most cases. At this age the goal is not to restore reproductive potential; the decision is made by weighing the testicle's size and function, the condition of the other testicle, and testicular cancer risk together. For a palpable testicle of reasonable size, orchiopexy (fixation in the scrotum) is considered; for a markedly small, non-functional testicle, orchiectomy (removal) comes into play; the options are discussed together in the pre-operative consultation.
Does retractile testicle occur in adults?
It's rare. The cremasteric reflex tends to fade as the testicle grows and becomes heavier during puberty; for this reason, a retractile (shy) testicle is not an expected finding in adults. In an adult, a testicle that cannot be felt in the scrotum usually means an undescended testicle carried over from childhood or one that ascended later, and it should be evaluated with an exam.
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