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Prof. Dr. Ali Avanoğlu
Undescended Testicle • Special situations

What Changes When Undescended Testicle and Hypospadias Occur Together?

Undescended testicle and hypospadias (in which the urinary opening is located on the underside of the penis rather than at its tip) can occur together in the same child. In most cases, the two conditions are independent of one another; however, when proximal (more posteriorly located) hypospadias occurs together with a non-palpable testicle in particular, an additional evaluation is carried out before surgery, and treatment is managed by a team that plans both conditions together.

Who this is forFamilies of children who have both an undescended testicle and hypospadias
Reading≈6 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 inguinal canal · bilateral
01 · Why do they occur together?02 · When is additional evaluation needed?03 · What does the testing involve?04 · How are the two operations planned?05 · Long-term joint follow-up
In brief5 madde
  • Why do they occur together?: Undescended testicle and hypospadias occur together from time to time because the development of the penis and testicles in the womb depends on the same hormonal signals.
  • When is additional evaluation needed?: The reason for additional evaluation is that, in some children, the combination of these two findings can be part of a broad group of conditions known as differences…
  • What does the testing involve?: The evaluation consists of blood tests and, when needed, ultrasound; it is not taxing for the child.
  • How are the two operations planned?: Undescended testicle and hypospadias are usually managed by the same team, in a sequence that takes each condition into account; which procedure is done first, or…
  • Long-term joint follow-up: When the two conditions occur together, follow-up proceeds together as well; checkup appointments are usually combined.
01

Why do they occur together?

Undescended testicle and hypospadias occur together from time to time because the development of the penis and testicles in the womb depends on the same hormonal signals.

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  • Testicular descent and the closure of the urinary channel to the tip of the penis are completed during similar periods of pregnancy, largely under the influence of androgens produced by the testicle. When this signal is weak, or when the tissue does not respond to it sufficiently, both processes can be disrupted together. The literature reports that undescended testicle is more common in children with hypospadias than in the general population, and that this co-occurrence increases as the hypospadias is located further back (more proximally).
  • By contrast, distal (near the tip) hypospadias together with a unilateral, palpable undescended testicle in the groin is most often a coincidental combination, and each condition is treated along its own usual course.
02

When is additional evaluation needed?

The reason for additional evaluation is that, in some children, the combination of these two findings can be part of a broad group of conditions known as differences of sex development (DSD).

  • Proximal hypospadias + non-palpable testicle (unilateral or bilateral)
  • Bilateral non-palpable testicles (regardless of the degree of hypospadias)
  • Hypospadias + a markedly small penis or a bifid scrotum
  • A similar family history or other accompanying congenital findings
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  • This possibility comes up in particular with the following combinations: proximal hypospadias together with a non-palpable testicle, bilateral non-palpable testicles, or hypospadias accompanied by a markedly small penis or a bifid (split) scrotum. In these situations, guidelines recommend karyotype (chromosome analysis) and hormone evaluation before surgical planning; pediatric urology, endocrinology, and, when needed, genetics work together.
  • We want to explain this step to families in calm, reassuring terms: the purpose of the evaluation is to confirm that, in most children, no additional diagnosis will emerge, and, in the rare cases where one does, to ensure that planning is built on the right foundation. The results usually do not change the surgical decision; however, taking a child with proximal hypospadias and a non-palpable testicle to surgery without this evaluation is not recommended.
03

What does the testing involve?

The evaluation consists of blood tests and, when needed, ultrasound; it is not taxing for the child.

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  • Karyotyping shows the chromosomal makeup. The hormone panel assesses AMH and inhibin B, which reflect the presence and function of testicular tissue, the pituitary hormones FSH and LH, and testosterone and its precursors; the natural hormone surge in the first months of life, known as 'mini-puberty,' offers a convenient window for these measurements. When needed, an hCG stimulation test measures the testosterone response of testicular tissue. A pelvic ultrasound may be requested to assess structures inside the abdomen.
  • Results are usually completed within a few weeks, and surgical planning is based on this information. This evaluation, carried out with endocrinology, also lays the groundwork for monitoring pubertal development and reproductive potential in later years.
04

How are the two operations planned?

Undescended testicle and hypospadias are usually managed by the same team, in a sequence that takes each condition into account; which procedure is done first, or whether both are done in the same session, depends on the location of the testicle and the degree of hypospadias.

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  • When a palpable testicle in the groin occurs together with distal hypospadias, both repairs can be performed under a single anesthetic in one session, so the child is put under anesthesia only once and goes through a single recovery period. For a non-palpable testicle, examination under anesthesia and diagnostic laparoscopy are performed first; if a testicle is found and can be brought down in a single session, hypospadias repair can be planned for the same session or a separate one. If a staged testicular procedure (Fowler–Stephens or Shehata) is needed, the sequence is arranged with both conditions in mind.
  • In terms of timing, the guideline windows for the two conditions overlap: 6 to 12 months for orchiopexy (fixing the testicle in the scrotum), and generally 6 to 18 months for hypospadias repair. In our practice, two pediatric urologists plan this together; laparoscopy, orchiopexy, and hypospadias repair are handled by the same team, and combined into a single session when appropriate. The technique, number of stages, and recovery for hypospadias repair itself are covered in detail in a separate section.
05

Long-term joint follow-up

When the two conditions occur together, follow-up proceeds together as well; checkup appointments are usually combined.

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  • For the testicle, its position, growth, and volume at puberty are assessed; for hypospadias, urinary stream, the position of the opening, and curvature are evaluated. In children who had hormone evaluation before surgery, pubertal development is monitored together with endocrinology; in cases with a history of bilateral or high-positioned testicles, semen analysis is planned for adulthood.
  • Follow-up through adolescence and adulthood continues with the same team, with adult urology included in that team. In this way, the record that began in childhood continues without interruption into the years when questions about fertility and sexual health arise.
Undescended Testicle video guide15 short videos, in order
Frequently asked questions
Does being asked for a karyotype mean something is wrong?
No. When proximal hypospadias occurs together with a non-palpable testicle, karyotype and hormone evaluation is a standard step recommended by guidelines. In most children, the results come back as expected; the goal is to avoid missing rare situations and to build planning on the right foundation.
Can both operations be done on the same day?
In most cases, yes. A palpable testicle in the groin together with distal hypospadias can be repaired together under a single anesthetic. For a non-palpable testicle, the two procedures are planned either in the same session or separately, depending on the laparoscopy findings; the decision is made through joint assessment by two specialists.
Which operation should be done first?
There is no fixed rule; in most cases, both are done together. If separate sessions are needed, orchiopexy is generally not delayed, since the amount of time the testicle spends in a warm environment matters; hypospadias repair is then planned accordingly, within its own guideline window.
Does this combination affect the ability to have children later in life?
With a history of unilateral, palpable groin testicle together with hypospadias, paternity rates are close to those of the general population. When bilateral or high-positioned testicles occur together with proximal hypospadias, reproductive potential is monitored more closely; a definitive assessment is made in adulthood with semen analysis and a hormone profile.
Prof. Dr. Ali Avanoğlu's publications on this topic · 1
  1. Tiryaki S, Tekin A, Yagmur İ, et al. (2018). Parental Perception of Terminology of Disorders of Sex Development in Western Turkey. Journal of clinical research in pediatric endocrinology. PubMed ↗
←Previous • Special situationsTesticular Agenesis (Absent Testicle)
Related pagesFull index →
Diagnosis and evaluationBilateral Non-Palpable TesticleBoth testicles being non-palpable is a different topic from unilateral undescended testicle. Here the first question isn't 'where are the testicles' but 'is there testicular tissue, and is it functioning' — so hormonal, and if needed genetic, evaluation is carried out before surgery. This page explains why and how, in plain language.BasicsUnilateral and Bilateral Undescended TesticleAbout one-third of undescended testicle cases are bilateral, and this distinction changes the treatment plan. In a unilateral case, the other testicle is healthy and the paternity rate is close to that of the general population; in a bilateral case, both testicles are affected, so reproductive potential is more significantly affected, and hormonal evaluation and early surgery become even more important.Surgery in childrenWhat Is Orchiopexy?Orchiopexy is the umbrella term for undescended testicle surgery: the testicle and its blood vessels are freed from surrounding tissue, brought down into the scrotum without tension, and fixed in place there. The surgical approach and number of stages may vary, but the backbone of the operation is the same.Surgery in childrenWhen Is Surgery Needed? TimingFor undescended testicle, the question of “when” matters as much as “how.” Guidelines define the first six months as a watch-and-wait period, with 6–12 months as the target window for orchiopexy (fixing the testicle in the scrotum); this page explains the reasoning behind this timeline and its exceptions.
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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